Microsurgical management of anterior communicating artery aneurysms

OBJECTIVE: Aneurysms of the anterior communicating (ACOM) artery are the most frequently occurring type of ruptured intracranial aneurysms. The peculiar anatomy of the anterior communicating artery complex, its anatomic variations, and its multiple perforators, along with the deep location of these aneurysms and our difficulty accessing them, pose challenging anatomic problems in their surgical treatment. METHODS: We present our operative techniques for microsurgical treatment of ACOM artery aneurysms. Special, complex situations that may arise during treatment of these aneurysms and their solutions are also discussed. We highlight the technical aspects of microsurgical clipping of ACOM artery aneurysms. RESULTS: Operative videos are provided to illustrate the technical variations of approaching and clipping these aneurysms, the A3-A3 bypass technique, and the complexity of managing these aneurysms. CONCLUSION: Attention to detail is critical for successful treatment of ACOM artery aneurysms. Management of each patient must be tailored, because no one technique is suitable for all situations. Not all ACOM artery aneurysms can be coiled; therefore, the surgeon's microsurgical clipping technique is an important facet of managing these aneurysms.