Extended transsphenoidal approach to anterior communicating artery aneurysm: aneurysm incidentally identified during macroadenoma resection: technical case report.

Abstract

Full exposure of an aneurysm and surrounding structures with minimal brain retraction is important to eliminate the aneurysm safely and accurately. We describe an extended transsphenoidal approach for clipping an anterior communicating artery (ACoA) aneurysm. A 58-year-old woman had a surgical history significant for subtotal removal of a macroadenoma via the posterior portion of the planum sphenoidale using an extended transsphenoidal approach. During the tumor removal, a small unruptured ACoA aneurysm was incidentally found. The aneurysm was eliminated through the same operative route under a direct and wide view. The dural window was patched with abdominal fascia and sutured with 5-0 nylon in a watertight fashion. The extended transsphenoidal approach could expose an ACoA complex and aneurysm without substantial brain retraction. If the major limitations of this approach (e.g., postoperative cerebrospinal fluid leakage and meningitis) can be overcome using technical advances, this technique will offer a minimally invasive approach to the ACoA complex.