Extended endoscopic endonasal approach for clipping of anterior communicating artery aneurysm: A case report
Main Article Content
Abstract
The extended endoscopic endonasal approach (EEEA) for anterior communicating artery (ACoA) aneurysm clipping remains highly selective due to limited surgical corridor and vascular control challenges. We report a case of an unruptured ACoA aneurysm treated via EEEA at Bach Mai Hospital. A 59-year-old male presented with headache and was diagnosed with an unruptured ACoA aneurysm (5.86 × 5.02 × 4.47 mm) with a wide neck (dome-to-neck ratio 0.85), right A1 hypoplasia, and 90° rotation of the ACoA complex aligning both A2 segments coaxially with the endonasal trajectory. Preoperative 3D planning was conducted using CTA and DSA guided surgical corridor simulation and clip orientation. Intraoperatively, temporary clipping of the left A1 was performed, followed by successful titanium clip placement across the aneurysm neck. Postoperative CTA and DSA confirmed complete aneurysm occlusion with preservation of all parent vessels. The patient developed transient cerebrospinal fluid leak and bacterial meningitis, both resolved with conservative management. At 3-month follow-up, the patient achieved mRS 0 with full olfactory recovery. As such, EEEA is feasible for carefully selected ACoA aneurysms with favorable anatomy, with 3D preoperative planning being critical for surgical success.
Article Details
Keywords
Anterior communicating artery aneurysm, extended endoscopic endonasal approach, aneurysm clipping, 3D preoperative planning
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