This video reviews techniques for clip ligation of small M1, perforating or lenticulostriate aneurysms. This is a 52 year-old female who presented with subarachnoid hemorrhage from an anterior-communicating artery aneurysm. She subsequently underwent clip ligation of this ruptured aneurysm. However, an M1 small perforating aneurysm was also found on postoperative angiography that preoperative CTA did not demonstrate this small aneurysm. You can see the morphology of the aneurysm is relatively small. However, since she has had a previous history of subarachnoid hemorrhage from another aneurysm, treatment was deemed necessary. Right frontotemporal craniotomy was completed. You can see the M1, the origin of the perforating vessel from the neck of the aneurysm. The neck of the aneurysm was completely dissected. Straight clip was placed across the neck of the aneurysm, preserving the origin of the perforating vessel, traveling more medially. Intraoperative flow scene, as well as ICG, confirmed patency of the important lenticulostriate artery. You can see the results of the ICG as well, and this patient made an excellent recovery after her surgery. Thank you.
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