Pericallosal Artery Aneurysm: Complex Wide-necked Aneurysm Located at a Pericallosal Artery Trifurcation; Microsurgical Clipping and Complete Obliteration of the Aneurysm with Preservation of the Efferent Vessels and with Good Clinical Outcome
An unruptured left-hand pericallosal aneurysm was coincidentally found in a patient as a part of a renewed multiple sclerosis workup in 2017. To better evaluate the morphology of the lesion, digital subtraction angiography was carried out, which showed a broad-based, posteriorly directed aneurysm located on the level of the arterial trifurcation of the left A3 segment. The outlets of the three A3 segments were incorporated in the aneurysmal neck. Due to the unfavorable vascular architecture, endovascular management was not recommended. The case was reviewed in a broad discussion by the neurovascular and neurointerventional team, and a procedure to clip the left-hand pericallosal aneurysm was scheduled. The clipping was done via a small, left-hand frontal craniotomy, with this microsurgical procedure monitored through intraoperative ICG angiography. The procedure was well tolerated, and the complete obliteration of the aneurysm was confirmed on the follow-up angiography. The microsurgical clipping of aneurysms located in the pericallosal artery is the main topic of this chapter.