CASE REPORT article
Front. Surg.
Sec. Neurosurgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1673454
This article is part of the Research TopicDoing More with Less: Neurosurgery Strategies and Tricks of the Trade in the Technological EraView all 7 articles
Microsurgical Clipping of a Multilobular Fenestrated Anterior Communicating Artery Aneurysm: Technical Challenges with Video Analysis
Provisionally accepted
Ufuk Erginoglu
Arzum UyanikerCagdas AtaogluUmid Sulaimanov
Can KendirliogluErdem AkMinor Ross
Mustafa Baskaya*- University of Wisconsin - Madison, Madison, United States
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Background: The anterior communicating artery (AComA) is a common site for intracranial aneurysms due to its complex vascular architecture. Fenestrations in the AComA, observed in 7.5– 40% of cases, can disrupt normal blood flow, which increases turbulence and shear stress and heightens the risk of aneurysm formation. Case Description: We report the case of a 67-year-old female who presented with headaches. Imaging revealing a 10 mm unruptured multilobular aneurysm arising from the AComA. Microsurgical clipping was performed via a right pterional craniotomy. The fenestrated nature of the AComA only became apparent after intraoperative full dissection of the AComA complex. Intraoperative Doppler ultrasound and indocyanine green angiography were used to evaluate the vascular anatomy, which was followed by the successful clipping of the aneurysm. Postoperative angiography verified complete obliteration, and the patient recovered without neurological deficit. Conclusion: The complexity of the AComA anatomy in this case prompted reflection on the limitations of preoperative imaging and the need for careful intraoperative planning. Although advanced imaging modalities, particularly three-dimensional rotational angiography, are crucial for detecting vascular anomalies, ultra-thin bridging vessels may remain undetected, as occurred in this case. Intraoperative recognition of these structures required real-time adaptation to ensure safe dissection and successful aneurysm clipping To our knowledge, this is the first operative video documenting microsurgical clipping of an unruptured aneurysm within a fenestrated AComA. This case underscores the importance of anticipating anatomical variations and adapting surgical strategies to optimize outcomes in complex cerebrovascular procedures.
Keywords: aneurysm clipping, Anterior Communicating Artery (AComA) Aneurysm, Duplicated/Fenestrated Aneurysm, duplication, fenestration, Multilobular aneurysm, Pterional craniotomy
Received: 25 Jul 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Erginoglu, Uyaniker, Ataoglu, Sulaimanov, Kendirlioglu, Ak, Ross and Baskaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mustafa Baskaya, University of Wisconsin - Madison, Madison, United States
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