• Nuno Cubas Farinha, Pedro Plou, Kosumo Noda, Jared Paul Golidtum, Nakao Ota, and Rokuya Tanikawa.
• Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan; Department of Neurosurgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal. Electronic address: nuno.cubas.farinha@gmail.com.
• World Neurosurg. 2024 Oct 22.

AbstractDistal anterior cerebral artery (ACA) aneurysms comprise 4-5% of all intracranial aneurysms.1-3 Rarely, these aneurysms can be complex and less amenable to conventional clipping or endovascular techniques, requiring alternative treatment strategies.4,5 Surgical modalities employed in these situations may involve trapping and flow replacement techniques to exclude the aneurysm while maintaining normal perfusion to the affected territories.4-7 In this video, we describe the Modified Trapping Technique for cases where two branches arise from the aneurysm and cannot be sacrificed. This technique involves the transposition of one of the branches and its reimplantation distally to the lesion. The aneurysm is then clipped, trapping the segment from which the disconnected branch originated, while preserving anterograde blood flow to both non-occluded and reimplanted branches. Compared to complete trapping in similar situations, this technique prevents the formation of a dead-end in the parent artery that could lead to thrombosis,8 poses no risk to uninvolved arteries and requires only one anastomosis. This technique was applied in a 54-year-old female patient who presented at our institution with an incidental fusiform distal ACA aneurysm diagnosed after head trauma. Imaging demonstrated that the aneurysm originated from a bihemispheric ACA with two pericallosal arteries arising from it. The patient tolerated the procedure well, and postoperative imaging showed complete aneurysm occlusion and patency of both the non-occluded and reimplanted pericallosal arteries. The patient consented to the procedure and the publication of her images. Institutional review board approval was deemed unnecessary.Copyright © 2024. Published by Elsevier Inc.

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