A Case of Giant Thrombosed Distal Anterior Cerebral Artery Aneurysm Successfully Treated Using Hemi-bonnet Bypass

Abstract

A 74-year-old man presented with a giant thrombosed aneurysm (maximum diameter: 37 mm) which was incidentally found in the left distal anterior cerebral artery. The left A3 was branching from the aneurysm dome; thus, revascularization was essential. The left callosomarginal artery was anastomosed to the radial artery graft in end-to-side fashion with the conduit passing along a gutter in the frontal bone, then the end of the radial artery was anastomosed to the superficial temporal artery in end-to-side fashion, forming the hemi-bonnet bypass. The aneurysm was trapped and thrombectomy was performed. No complications were observed. Bypass patency was confirmed 3 years after the operation. Revascularization of the anterior cerebral artery by hemi-bonnet bypass is easy to anastomose and safe.