title: Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature.
abstract: BACKGROUND
  Dissecting aneurysms of the cerebral arteries are uncommon vascular malformations. Neurosurgical treatment remains critical in the management of patients with such vascular pathologies.
  
  
  METHODS
  A 20-year-old Caucasian woman presented with a sudden onset of severe headache and loss of consciousness. Computed tomography revealed diffuse subarachnoid hemorrhage, while a computed tomography disclosed a dissecting aneurysm of the precommunicating segment of the right anterior cerebral artery. Cerebral carotid angiography confirmed the presence of the dissecting aneurysm. Due to the peculiar anatomic configuration, endovascular treatment was excluded and surgery was selected. As the left circulation perfused both postcommunicating segments of the anterior cerebral artery and the distal right precommunicating segment was hypoplastic, direct clipping of the right precommunicating segment, close to its origin from the internal carotid artery, was carried out. She recovered after surgery and a late angiography showed the correct positioning of the clip, with regular perfusion of both right and left postcommunicating segments.
  
  
  CONCLUSIONS
  The management of dissecting aneurysms of the cerebral arteries is still controversial. With this report we highlight a possible neurosurgical option among therapeutic strategies for these uncommon vascular lesions.
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy. oreste.dedivitiis@unina.it.
authors.forename: Oreste
authors.initials: O
authors.lastname: de Divitiis
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy. albertodisomma87@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Somma
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy. teresa.somma85@gmail.com.
authors.forename: Teresa
authors.initials: T
authors.lastname: Somma
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy. lcavallo@unina.it.
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Cavallo
authors.affiliation: Department of Advanced Biomedical Sciences, Unit of Interventional Neuroradiology, Università degli Studi di Napoli "Federico II", Naples, Italy. mariano.marseglia@unina.it.
authors.forename: Mariano
authors.initials: M
authors.lastname: Marseglia
authors.affiliation: Department of Advanced Biomedical Sciences, Unit of Interventional Neuroradiology, Università degli Studi di Napoli "Federico II", Naples, Italy. francesco.briganti@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Briganti
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy. paolo.cappabianca@unina.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D055815:Young Adult