This is a classic video for describing clip ligation of Internal Carotid Artery Bifurcation Aneurysms, using the fluorescent technologies. This is a 52 year-old male who presented with an incidental six millimeter right-sided ICA bifurcation aneurysm, and subsequently underwent a right frontotemporal craniotomy. You can see the location of the aneurysm and its morphology. Following exposure of the Sylvian fissure, the M1 branch was identified within the fissure and gentle mobilization of the frontal lobe, using dynamic retraction techniques, allowed me to expose the neck of the aneurysm. The passageway of the clip blades, were carefully cleared. You can see the A1 was exposed. The medial neck of the aneurysm was freed from any perforating vessels. Here again, the dissection around the anterior neck of the aneurysm. Temporary clip was placed across the ICA. Here's the dissection of A1, just posterior to the neck of the aneurysm. All the perforators were preserved. Straight clip was deployed across the neck of the aneurysm, and intraoperative fluorescence using both ICG, which was relatively grainy, and the results of flow within the vessels, are not very clear. However, the results of the fluorescein angiography were much more desirable, confirming the patency of the branching vessels and perforating arteries. You can see the A1. The aneurysm is completely excluded, and this patient recovered from his surgery uneventfully. Thank you.
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