Giant anterior communicating artery aneurysm treatment
Giant anterior communicating artery aneurysm is, as a rule, treated by an approach from the direction in which early arrival at the aneurysm neck is accomplished. Approaching from the side of dominant A1 is generally recommended, but for such an aneurysm that projects anteriorly, the interhemispheric approach is recommended.
see Pterional approach for anterior communicating artery aneurysm.
Because current stent techniques include flow-diverting devices, even giant or thrombotic aneurysms can be effectively treated by endovascular methods. However, surgical clipping still retains an important method in some cases, especially for giant wide-necked aneurysms for which isolation and bypass may be the only optimal treatment 1).
Proximal ACA occlusion, even of dominant A1 segments with small or no contralateral A1 artery, was an effective treatment alternative and was well tolerated as a result of excellent leptomeningeal collateral circulation 2).
Endovascular treatment
Videos
Left Callosomarginal to Right Pericallosal In Situ Bypass, Partial Trapping, and Thrombectomy of a Giant Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video 3).