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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
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Microsurgical Clip Ligation of Ruptured, Previously Coiled A2-A3 Aneurysm Through Interhemispheric Approach in a
Vincent N Nguyen1, Kara Parikh1, Stephanie Einhaus2
1Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, USA.
World Neurosurgery
|April 7, 2022
Summary
Recurrent aneurysms after coil treatment pose risks. This case highlights successful microsurgical clipping of a recurrent anterior cerebral artery aneurysm, preserving critical venous structures.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Ruptured aneurysms treated with coil embolization can recur, necessitating alternative treatment strategies.
- Surgical options like coil extraction, trapping, and bypass exist when clipping is not feasible.
- Distal anterior cerebral artery aneurysms present unique anatomical challenges.
Observation:
- A 15-year-old male presented with a Hunt and Hess grade 4, Fisher grade 4 subarachnoid hemorrhage from a ruptured distal anterior cerebral artery aneurysm.
- Initial treatment involved coil embolization and corpus callosum hemorrhage evacuation.
- Follow-up angiography revealed early aneurysm recurrence.
Findings:
- Successful microsurgical clipping was achieved via an anterior interhemispheric approach.
- Careful preservation of a large venous complex was critical to prevent venous infarction.
- The surgical video details the case, anatomy, technique, and outcomes.
Implications:
- This case demonstrates the feasibility and importance of microsurgical clipping for recurrent cerebral aneurysms.
- Preserving venous drainage is paramount in complex anterior cerebral artery aneurysm surgery.
- Strategic planning and advanced surgical techniques are crucial for managing complex aneurysm recurrences.
