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Acta neurochirurgica
Oct 05, 2024;166 (1): 395.

Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it.

R Chase Ransom, Stephen Graepel, Giuseppe Lanzino, Lorenzo Rinaldo
Author Information
  1. R Chase Ransom: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
  2. Stephen Graepel: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
  3. Giuseppe Lanzino: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
  4. Lorenzo Rinaldo: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. rinaldo.lorenzo@mayo.edu.
PMID: 39367893 DOI: 10.1007/s00701-024-06279-5

Abstract

BACKGROUND: Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure.
METHOD: The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided.
CONCLUSION: Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.

Keywords

Aneurysms Anterior communicating artery Microneurosurgery Surgical clipping

References

  1. Chen J et al (2020) Anterior communicating artery aneurysms: anatomical considerations and microsurgical strategies. Front Neurol 11:1020 [DOI: 10.3389/fneur.2020.01020]
  2. Hage ZA, Charbel FT (2015) Clipping of bilateral MCA aneurysms and a coiled ACOM aneurysm through a modified lateral supraorbital craniotomy. Neurosurg Focus 38(VideoSuppl1):1Video19 [DOI: 10.3171/2015.V1.FOCUS14604]
  3. Hyun SJ, Hong SC, Kim JS (2010) Side selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms. J Clin Neurosci 17(5):592–596 [DOI: 10.1016/j.jocn.2009.09.024]
  4. International Study of Unruptured Intracranial Aneurysms I (1998) Unruptured intracranial aneurysms–risk of rupture and risks of surgical intervention. N Engl J Med 339(24):1725–33 [DOI: 10.1056/NEJM199812103392401]
  5. Raper DMS et al (2020) Definitive treatment with microsurgical clipping after recurrence and rerupture of coiled anterior cerebral artery aneurysms. Oper Neurosurg (Hagerstown) 19(4):393–402 [DOI: 10.1093/ons/opaa103]
  6. Wiebers DO et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110 [DOI: 10.1016/S0140-6736(03)13860-3]

MeSH Term

Humans
Intracranial Aneurysm
Surgical Instruments
Neurosurgical Procedures
Subarachnoid Hemorrhage
Craniotomy
Middle Aged
Female
Journal Article Case Reports

Word Cloud

Created with Highcharts 10.0.0clippingACOManeurysmsposterior-superiorlyprojectingcancommunicatingarterySurgicalAnteriorAneurysmsclipBACKGROUND:amongcommonassociatedaneurysmalsubarachnoidhemorrhageInternationalStudyUnrupturedIntracranialNEnglJMed339:1725-17331998WiebersLancet362:103-1102003challengingipsilateralA2interferetrajectoryperforatingvesselsobstructedviewIntraluminalcoilsincreasedifficultyprocedureMETHOD:relevantsurgicalanatomyillustrationpresentedvideodetailingtechniqueillustrativecaseprovidedCONCLUSION:requirecomplexconfigurationsdescribekeystepsaneurysmlateralsupraorbitalcraniotomyfenestratedtandemFenestratedpreviouslycoiledanterioraneurysms:itMicroneurosurgery

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