ICA Bifurcation Aneurysm: Brain Swelling

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This video describes clip ligation of a ruptured ICA Bifurcation Aneurysm in the presence of Brain Swelling. This is a 32 year-old female, who presented with a dysmorphic left-sided ICA bifurcation aneurysm. Pre-operative imaging, including the CT, revealed some evidence of brain swelling in the area. There is no obvious Hydrocephalus apparent. Cerebral Arteriogram demonstrated the dysmorphic nature of the aneurysm across the ICA bifurcation. She underwent to Left Frontotemporal Craniotomy for clip ligation of her aneurysm. Despite numerous medical measures, including placement of an EVD, the brain appeared very tense. The Sylvian Fissure was dissected. Fixed retractors were used. Temporary clip was placed across the ICA. You can see the A1. The bifurcation is located here. The neck of aneurysm is apparent. I carefully continue to dissect around the neck of the aneurysm, protecting the mild perforating vessels, at the level of the bifurcation. Here, you can see the neck of the aneurysm or medially creating space for the clip blades. An angle clip was used in this case to collapse the neck of the aneurism. Intraoperative ICG revealed, complete exclusion of the aneurysm and the Postoperative Angiogram also confirmed, complete ligation of the aneurysm. The CT, did not demonstrate any evidence of Ischemia and this patient made an excellent recovery. Despite the presence of brain swelling, we continued the operation because we did not feel that the amount of retraction was hazardous. Obviously, this is a ruptured aneurysm that was not amenable to coil embolization and its exclusion to avoid repleting is essential. Thank you.

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