Abstract
We report a series of surgical treatment for anterior communicating artery (Acom. A) aneurysm with fenestration. A preoperative angiogram is a must for demonstrating Acom. A, because around the Acom. A there are many perforating arteries seen crossing. Also when there is an abnormality of Acom. A, for example fenestration, duplication and etc., it is not clearly seen. It is a well-known that fenestration has a lack of arterial media and is potentially weak, so an abnormal blood flow has taken place and an aneurysm has occurred at the point of fenestration. For the cases where aneurysms with fenestration cannot be seen by angiogram we have succeeded in using a 3D-CT to show the point of fenestration.
It is necessary to determine an accurate surgical approach because in Acom. A with fenestration the space for moving is very limited. To get a good operative view when an aneurysm is anteriorly placed, it is better to approach from behind the A2 side.
If an aneurysm is posteriorly placed, it is better to approach from the front of A2.
We treated 5 Acom. A with fenestration and report 4 of them.
