A1–A2 Fenestration Tube Technique for Clipping a Ruptured Anterior Communicating Artery Aneurysm

Abstract

A fenestration tube is a clipping reconstruction technique that allows the preservation of critical vessels in aneurysm surgery. A patient with a ruptured anterior communicating artery (ACoA) aneurysm with a posterior projection was admitted to our neurosurgery unit. A right dominant A1 with rotation of the A2 fork was observed on preoperative computed tomography angiography (CTA). During surgery, we observed that the recurrent artery of Heubner branched off the A2 just distal to the neck of the aneurysm. Successful clipping was achieved by building an “A1–A2 fenestration tube,” with preservation of the recurrent artery and of the ACoA perforators. Surgical nuances and the advantages of fenestration tubes are discussed.

Resumo

O tubo de fenestração é uma técnica de clipagem e reconstrução que permite a preservação de vasos críticos na cirurgia de aneurismas. Um paciente com um aneurisma da artéria comunicante anterior (ACoA) rompido com projeção posterior foi admitido em nosso serviço. A dominante direita A1 com rotação do garfo A2 foi observada na angiografia por tomografia computadorizada (ATC). Durante a cirurgia, a artéria recorrente foi observada ramificando-se a A2 apenas distal ao colo do aneurisma. Uma clipagem bem-sucedida foi alcançada criando um tubo de fenestração “A1–A2,” com preservação da artéria recorrente e dos perfurantes da ACoA. Nuances cirúrgicas e as vantagens dos tubos de fenestração são discutidas.

Keywords

intracranial aneurysm - anterior communicating artery - microsurgery

Palavras-chave

aneurisma intracraniano - artéria comunicante anterior - microcirurgia

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