Anterior cerebral artery side-to-side bypass and aneurysm trapping: Technical nuances and a contingency-based revascularization strategy.

Abstract

Fusiform aneurysms of the anterior cerebral artery (ACA) may require trapping with revascularization, particularly when distal flow is uncertain. Preoperative distinction between fixed dissection-related stenosis and vasospasm remains challenging. The author describes a flexible revascularization strategy in which a limited extension of a modified bicoronal incision allows preparation of the frontal branch of the superficial temporal artery (STA) as a standby interposition graft. Following intraoperative papaverine application and improvement in vessel caliber, in situ ACA side-to-side bypass was performed without graft interposition. Key technical nuances of the side-to-side bypass are demonstrated. This approach integrates technical refinement in side-to-side bypass with pragmatic contingency planning, enabling tailored revascularization based on intraoperative anatomical and technical feasibility.