153

Aneurysms of the Anterior Cerebral Artery: Pericallosal Artery

Aneurysms of the Anterior Cerebral Artery:
Pericallosal Artery

Special Pericallosal artery aneurysms are usually
Considerations small (<1 cm) and are located at the divi-
sion of the anterior cerebral artery (ACA)
into the pericallosal and the callosomargi-
nal arteries, distal to the genu of the corpus
callosum. These aneurysms are fragile, fre-
quently rupture prematurely during expo-
sure, and have a morbidity higher than

expected from their angiographic appear-
ance and location. We prefer prompt surgi-
cal treatment because many patients
experience early recurrent hemorrhage.

154 Aneurysms of the Anterior Circulation

Cingulate
cyrus

2.111

2.112

Approach A frontal parasagittal craniotomy is made
as for a standard interhemispheric callosal
approach (see Chapter I). The patient is
placed in the supine position with the head
flexed and maintained in 0 degrees rotation.
The thorax is elevated 15 degrees.

2.111 Two 15-mm self-retain-
ing retractor blades are placed on the falx
and medial surface of the frontal lobe. The
cingulate gyri are separated by incision of
the tough arachnoid adhesions, which fuse
them in the midline.

2.112 A cortical branch of the
callosomarginal artery can be followed to
its junction with the ACA. The aneurysm is
buried in the juncture of the two vessels. A
hematoma and subarachnoid hemorrhage
frequently obscure the anatomy of the an-
eurysm. It is prudent to secure control of
the ACA proximal to the aneurysm.

155

Aneurysms of the Anterior Cerebral Artery: Pericallosal Artery

2.113

2.113 The aneurysm base and
its adherence to the proximal pericallosal
artery are identified.

2.114 With a temporary clip
applied to the ACA proximal to the aneu-
rysm or with suction over the aneurysm
dome, the aneurysm base is dissected free
of its adhesions to the brain and the
pericallosal and callosal marginal arteries.

2.114

15f Aneurysms of the Anterior Circulation

2.115

2.115 A J-shaped clip is ap-
plied as a microretractor assists in exposure
of the aneurysm neck.

2.116 The aneurysm is aspi-
rated as the clip is closed.

2.116

157

Aneurysms of the Anterior Cerebral Artery: Pericallosal Artery

2.118

2.117,2.118 The collapsed an-
eurysm sac is reflected to ascertain the pat-
ency of the pericallosal and callosomarginal
arteries. The clot in the interhemispheric
fissure is removed with copious irrigation.

Closure Closure is performed as for a standard
interhemispheric callosal approach (see
Chapter I).

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