• Sung Ho Lee, Yeongu Chung, Ji Wook Ryu, Seok Keun Choi, and Byung Duk Kwun.
• Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
• World Neurosurg. 2018 Mar 1; 111: e507-e518.

BackgroundMany methods for treating complex anterior cerebral artery (ACA) aneurysms are available; however, there is substantial variation among methods because of various aneurysm locations, the relationship of the aneurysm to arterial branches, aneurysm size and other morphologic characteristics, and the diameters of the parent or branching arteries.MethodsWe reviewed complex ACA aneurysms based on both our own experience and the available literature. Each unique case is analyzed in terms of the characteristics of the aneurysm, along with analysis and classification of the revascularization method used. Computer tablet-drawn illustrations of each unique technique are provided for comprehension and application in various situations.ResultsOver 6 years, we treated 5 cases of complex ACA aneurysms (1 precommunicating, 1 communicating, 1 postcommunicating, and 2 precallosal-supracallosal segment) with revascularization. Side-to-side anastomoses included pericallosal ACA segment-pericallosal ACA segment in 3 cases, supracallosal ACA segment-supracallosal ACA segment in 1 case, and ipsilateral callosomarginal artery-pericallosal artery in 1 case. Final modified Rankin scale score was 0 in 4 of 5 cases and 3 in 1 case. Six treatment strategies were used for the precommunicating aneurysm, 8 for the communicating aneurysm, 7 for the postcommunicating aneurysm, and 9 for the 2 precallosal-supracallosal segment aneurysms.ConclusionsTreatment of complex ACA aneurysms should be tailored according to the location and nature of the aneurysm and collateral circulation. Viable and feasible treatment strategies must be established by the neurovascular surgeon.Copyright © 2017 Elsevier Inc. All rights reserved.

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