SURGICAL VIDEO Microsurgical Clip Reconstruction of a 1 cm Complex Anterior Communicating Artery Aneurysm via an Orbitozygomatic Approach: 2-Dimensional Operative Video Gary Rajah, MD, Richard Justin Garling, MD, Murali Guthikonda, Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ opx208 MD, Leonardo Rangel-Castilla, MD Department of Neurosurgery, Wayne State University, Detroit, Michigan A 55-yr-old female with progressive visual disturbances placement, and gyrus rectus resection with interhemispheric underwent imaging that demonstrated a 1 cm complex anterior dissection was performed for improved exposure. Temporary communicating artery aneurysm (ACoA) compressing the optic anterior cerebral arteries (both A1s and A2s) clips allowed chiasm. On angiography evaluation, the aneurysm’s neck involved placement of 2 large fenestrated permanent clips. Complete both A1s and A2s. Given the large neck and involvement of the aneurysm obliteration was confirmed by intraoperative angiog- ACoA complex, it was decided that endovascular management raphy. Postoperatively, at last follow-up, the patient remained would likely result in high rates of recanalization or parent neurologically intact. artery occlusion. We performed a right modified orbitozy- gomatic craniotomy, with proximal control and dissection of Disclosure the aneurysm and small perforator arteries. Dome coagulation The authors have no personal, financial, or institutional interest in any of the under temporary occlusion was utilized to create space for clip drugs, materials, or devices described in this article. OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 6 | JUNE 2018 | 707 Downloaded from https://academic.oup.com/ons/article-abstract/14/6/707/4283107 by Ed 'DeepDyve' Gillespie user on 21 June 2018
Operative Neurosurgery – Oxford University Press
Published: Sep 29, 2017
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