Fusiform A1 aneurysms are frequently dissecting aneurysms. In this situations, a proximal parent vessel occlusion is the best strategy to manage a ruptured aneurysm. 41-year old male presented with an episode of spontaneous subarachnoid hemorrhage. 3D angiogram demonstrated the dissecting aneurysm along the distal end of A1 on the left side. Here's a better definition of the morphology of this aneurysm. This aneurysm remained stable and did not shrink on an angiogram few days later and therefore operative intervention was deemed necessary. Left front temporal craniotomy was completed, Here's the optic nerve, subfrontal area is being dissected away from the optic apparatus. Carotid arteries located here. Here's the dissecting or the fusiform aneurysm. Here's the artery of Huebner, located here. I placed a permanent clip, just proximal to the aneurysm. On A1, I did not feel distal occlusion of the aneurysm would be safe since the artery of Huebner could be sacrificed. Here's the ACom and here's the artery of Huebner traveling posteriorly. ICG demonstrated patency of the Huebner and some evidence of very minor flow within the aneurysm through retrograde flow. I was relatively satisfied with the results of the angiogram. Post-operatively this patient did not suffer from iris ischemia on the CT scan and eventually the aneurysm thrombose spontaneously, and this patient made an excellent recovery without any new neurological deficits. Thank you.
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