• Shintaro Arai, Tatsuya Sugiyama, Tohru Mizutani, and Ryo Irie.
• Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan. Electronic address: sarai@med.showa-u.ac.jp.
• World Neurosurg. 2024 Oct 1; 190: 278283278-283.

BackgroundSurgical treatment of large or giant thrombosed anterior cerebral artery (ACA) aneurysms often involves revascularization. Herein, we describe a unique and effective bypass technique to treat partially thrombosed giant distal ACA aneurysms in extremely narrow surgical corridors.MethodsA 68-year-old man underwent aneurysm trapping and ACA revascularization for a partially thrombosed giant ACA aneurysm in a surgical corridor that was narrow due to anatomic factors. By combining a side-to-side anastomosis and an end-to-side anastomosis at a single anastomotic site, we successfully redirected blood flow from the left pericallosal artery to the right pericallosal and callosomarginal arteries.ResultsPostoperatively, cerebral angiography showed that the blood flow in the aneurysm had disappeared, and the bypass remained open. The patient's functional disability gradually improved, and he reported consistently positive outcomes at the 6-month postoperative follow-up examination.ConclusionsThis revascularization technique may represent an effective novel treatment option, particularly when multiple revascularization procedures are required within a narrow surgical field.Copyright © 2024 Elsevier Inc. All rights reserved.

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