Bipolar coagulation remodeling or aneurysmorrhaphy is quite effective for clip ligation of rather bulbous middle cerebral artery or anterior temporal artery aneurysms. Let's review the technical nuances of this specific methodology, for the case of a 42 year old female, who presented with a right-sided six millimeter unruptured anterior temporal artery aneurysm. She also carried a strong family history of subarachnoid hemorrhage. Anterior temporal artery aneurysms can be quite broad base and they often include the origin of anterior temporal artery. Here's the imaging study and the 3D angiogram for this patient. The broad base expected neck of the aneurysm incorporating part of the origin of the anterior temporal artery. This patient underwent a right front temporal craniotomy. The anterior survey and fissure was widely dissected, and the aneurysm was exposed. You can see the distal M1, here is the aneurysm itself, the anterior temporal artery current around the medial neck of the aneurysm. I continued to better define the neck of the aneurysm, and dissect the origin of the anterior temporal artery. Here is the bipolar coagulation technique for reducing the girth of the aneurysm, and creating a more desirable, and practical neck for placement of the clip. Now placing the tentative permanent clip, allows another opportunity, for reducing the bulbous morphology of the aneurysm. The initial remodeling was performed under temporary occlusion of M1. Here is the final definitive clip placement. In tropical fluorescein angiography demonstrates complete exclusion of the aneurysm, and patency of ranching vessels, and avoidance of fixed retractors provides an atraumatic dissection of the Sylvian fissure for completion of their clip ligation procedure and postoperative angiogram demonstrates the desirable results. Which is complete exclusion of the aneurysm and its neck and adequate patency of the surrounding vessels. Thank you.
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