title: Surgical techniques for unclippable fusiform A2-anterior cerebral artery aneurysms and description of a frontopolar-to-A2 bypass.
abstract: BACKGROUND
  Fusiform aneurysms involving the A2 or distal A1-A2 segment of the anterior cerebral artery are uncommon and difficult to manage surgically with simple coiling or clipping.
  
  
  METHODS
  We illustrate four technical strategies to achieve complete obliteration of such complex aneurysms based on individual clinical conditions and imaging characteristics. Such treatments included combined open and endovascular techniques.
  
  
  RESULTS
  The techniques described include simultaneous clipping and wrap reinforcement of the aneurysm (clip-wrapping), flow reversal with A3-to-A3 bypass, trapping with A3-to-A3 bypass, and the use of an ipsilateral frontopolar-to-contralateral A2 bypass after resection of the aneurysm.
  
  
  CONCLUSIONS
  These techniques may involve endovascular and surgical options in an attempt to obtain the best overall outcome. Bypasses in the interhemispheric fissure, while difficult, are important, even necessary, adjuncts to treatment of these complex lesions.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Peng Roc
authors.initials: PR
authors.lastname: Chen
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: neuropub@dignityhealth.org.
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
mesh_terms: D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed
keywords: A2 fusiform aneurysm; Anterior cerebral artery; Bypass; Endovascular occlusion; Flow reversal; Surgical clipping; Wrapping