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Endoscopic clipping of an anterior communicating artery aneurysm

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Abstract

Background

Anterior communicating artery aneurysms are most prone to rupture. Surgically, they are conventionally being managed by a pterional approach. Some neurosurgeons prefer a supraorbital keyhole approach in select cases. Fully endoscopic clipping of such aneurysms is seldom described.

Method

We clipped an antero-inferiorly directed anterior communicating artery aneurysm endoscopically via a supraorbital keyhole approach. The intraoperative aneurysmal rupture was also managed endoscopically. The patient made an excellent postoperative recovery without any neurological deficits.

Conclusion

Select cases of anterior communicating artery aneurysms can be clipped endoscopically using standard instruments and adhering to the basic principles of aneurysm clipping.

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Abbreviations

CT :

Computed tomography scan

DSA :

Digital subtraction angiography

ACA :

Anterior cerebral artery

ICA :

Internal carotid artery

ACOM :

Anterior communicating artery

CSF :

Cerebrospinal fluid

WFNS :

World Federation of Neurological Surgeons

References

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, 492001, India

    Sanjeev Kumar, Debabrata Sahana, Ghanshyam Sasapardhi & Lavlesh Rathore

Authors
  1. Sanjeev Kumar
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  2. Debabrata Sahana
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  3. Ghanshyam Sasapardhi
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  4. Lavlesh Rathore
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Corresponding author

Correspondence to Sanjeev Kumar.

Ethics declarations

Informed consent

Informed consent was obtained from the individual participant included in the study. Full and detailed consent from the patient/guardian has been taken. The patient’s identity has been adequately anonymized. If anything related to the patient’s identity is shown, adequate consent has been taken from the patient/relative/guardian.

Conflict of interest

The authors declare no competing interests.

Additional information

Key points

1. Anterior communicating artery aneurysms are the most commonly encountered ruptured aneurysms in clinical practice.

2. The available management options are surgical clipping and endovascular coiling.

3. A detailed study of the preoperative angiogram images (both CT angiogram and DSA) is essential to understand the orientation of the aneurysm and its relationship with adjacent vessels.

4. Endoscopic clipping is feasible using the same principles as microsurgical clipping.

5. Endoscopes provide a dynamic, panoramic, and closer view of the angioarchitecture during clipping.

6. Before attempting endoscopic clipping, the surgeon should be well versed in the supraorbital keyhole approach and endoscopic surgery and its nuances.

7. Aneurysm surgery requires a meticulous dissection using a combination of blunt and sharp dissection to expose the aneurysm and its adjacent vessels.

8. Always prepare feeding vessels for temporary clip application if needed. The aneurysmal neck should be defined before dissecting the dome.

9. Apply the same technique of microsurgical clipping to manage intraoperative ruptures.

10. Postoperative care is of profound importance. A good setup with provisions for a microscope, endoscopes, DSA, and intensive care facilities is essential in the present-day vascular surgery practice.

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Supplementary information

Video A surgical video demonstrating the steps of endoscopic clipping of an anterior communicating artery aneurysm.

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Kumar, S., Sahana, D., Sasapardhi, G. et al. Endoscopic clipping of an anterior communicating artery aneurysm. Acta Neurochir 165, 1227–1231 (2023). https://doi.org/10.1007/s00701-023-05561-2

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  • DOI: https://doi.org/10.1007/s00701-023-05561-2

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