Direct surgical treatment of giant intracranial aneurysms on the anterior communicating artery or anterior cerebral artery.

Giant intracranial aneurysms on the anterior communicating artery (AComA) or anterior cerebral artery (ACA) are rare and treatment is very difficult. The outcome of direct surgical treatment of giant intracranial aneurysms on the AComA or ACA using vascular reconstruction techniques was assessed in five patients treated between 2006 and 2009. In all five patients, cerebral revascularization of ACA territory was performed to ensure blood flow in the distal ACA prior to treating the aneurysm. Trapping was performed in two patients, trapping and partial removal of the aneurysm in two patients, and total removal of the aneurysm with reanastomosis of ACA in one patient. Minor ischemic complication due to perforator ischemia was recognized in one patient and frontal lobe contusion in one patient. All patients were able to achieve functionally favorable outcome (modified Rankin scale 0 or 1). Insurance cerebral revascularization of the ACA territory enabled appropriate direct surgical strategies for giant AComA or ACA aneurysms tailored to each individual case, including trapping with or without removal of the aneurysm, and reanastomosis of the ACA with removal of the aneurysm.