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FIG 5. Patient with an AcomA aneurysm.
A, 3D-CTA (superior view) shows the insular vein (white arrow) emptying into the SPS. A black arrowhead and double black arrows indicate the AcomA aneurysm and the SSVs.
B and C, Via the pterional approach to the AcomA aneurysm, dissection of the aneurysm was attempted rostral (B) and caudal (C) to the bridging veins from the insular vein to the SPS (microscopic operative views). The white arrowhead, white arrow, black arrow, and SW indicate the bridging veins, the left anterior cerebral artery, the right anterior cerebral artery, and the sphenoid wing, respectively.
Retraction of the right frontal lobe was restricted, because the right frontal lobe was anchored to these bridging veins. Therefore, the aneurysmal neck was not completely explored. Because 3D-CTA depicted poor venous drainage from the insular cortex to the BVR, as shown in A, we could not sacrifice these veins and halted clipping of the aneurysm with this approach.
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