A3-A3 Bypass for Giant Anterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video

Large fusiform anterior cerebral artery aneurysms often require revascularization to allow for the treatment of the aneurysm and preservation of distal perfusion. The A3-A3 side-to-side anastomosis maintains ipsilateral distal perfusion. The inflow to the fusiform segment can then be clip occluded to treat the diseased vessel segment. This procedure is illustrated by the case in this video. The patient had a large right anterior cerebral artery fusiform aneurysm. An anterior interhemispheric craniotomy with the right side down was utilized for the approach. Postprocedural angiography demonstrated occlusion of the aneurysmal segment and patent distal perfusion within the ipsilateral distal segment. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.