This video discusses techniques for clip ligation of inferiorly pointing AcoA aneurysms. This is a 66 year-old female who presented with a small ruptured ACoA aneurysm. The morphology of the aneurysm is apparent. The left A1 was dominant in this case and determined the side of the craniotomy. The aneurysm is projecting inferiorly and could be adherent to your optic apparatus. And therefore frontal lobe retraction has to be minimized at least during the early parts of the operation. Left frontotemporal craniotomy was completed. The orbit, the inferior edge of the craniotomy was reduced flush with their level of the orbit. Here's A1, I continue with microdissection around the neck of aneurysm. Here is A2, artery of Huebner. Temporary occlusion of A1 was used. You can see the dome of the aneurysm is adherent to the optic apparatus. Exposure of the contralateral A1 can be challenging in this case, looking across the superior dome of the aneurysm in order to inspect the pathways for their clip blades. Here's a straight clip being placed across the neck of the aneurysm. Further inspections reveals good exclusion of the aneurysm and its neck. The tip of the blades are apparent all the way across the neck. ICG angiogram, further confirms obstetrician of the aneurysm sac. All the adjacent vessels are patent as expected and the postoperative imaging confirms complete exclusion of the aneurysm without any evidence of complicating features including ischemia on the CT scan, thank you.
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