Clipping of a Ruptured Small Anterior Communicating Artery Aneurysm: Technical Video

Abstract

In recent years there has been a significant shift in the management of intracranial aneurysms as the majority, both ruptured and unruptured, are being treated through an endovascular approach.1-3 However, there are still instances where open surgical clipping is the best option for definitive management. Both patient factors, such as age and co-morbidities, and aneurysm characteristics, such as size, morphology, and location must be taken into consideration when treating aneurysms. This is especially true for anterior1 communicating artery aneurysms as these have been treated successfully using multiple different techniques.4-5 There are no absolute guidelines indicating how a particular aneurysm should be treated and therefore, one must be able to determine how to best manage a patient based on their own skill set, knowledge, and experience. We present a case of a 61 year old female who presented with a ruptured anterior communicating artery aneurysm. Initially she was brought to the angiography suite to undergo possible endovascular treatment of the aneurysm, but after reviewing the morphology and size of the aneurysm it was felt that this aneurysm could not be treated safely through an endovascular approach and surgical clipping was the better option. The patient consented to the procedure. In this operative video, we describe the technical aspects of the surgical procedure and the benefits of our approach.