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Background <p>Fusiform aneurysms of the anterior cerebral artery (ACA) may require trapping with revascularization, particularly when distal flow is uncertain. Preoperative distinction between fixed dissection-related stenosis and vasospasm remains challenging.</p> Methods <p>The author describes a flexible revascularization strategy in which a limited extension of a modified bicoronal incision allows preparation of the frontal branch of the superficial temporal artery (STA) as a standby interposition graft. Following intraoperative papaverine application and improvement in vessel caliber, in situ ACA side-to-side bypass was performed without graft interposition. Key technical nuances of the side-to-side bypass are demonstrated.</p> Conclusion <p>This approach integrates technical refinement in side-to-side bypass with pragmatic contingency planning, enabling tailored revascularization based on intraoperative anatomical and technical feasibility.</p>

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Anterior cerebral artery side-to-side bypass and aneurysm trapping: Technical nuances and a contingency-based revascularization strategy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Gahn Duangprasert

摘要

Background

Fusiform aneurysms of the anterior cerebral artery (ACA) may require trapping with revascularization, particularly when distal flow is uncertain. Preoperative distinction between fixed dissection-related stenosis and vasospasm remains challenging.

Methods

The author describes a flexible revascularization strategy in which a limited extension of a modified bicoronal incision allows preparation of the frontal branch of the superficial temporal artery (STA) as a standby interposition graft. Following intraoperative papaverine application and improvement in vessel caliber, in situ ACA side-to-side bypass was performed without graft interposition. Key technical nuances of the side-to-side bypass are demonstrated.

Conclusion

This approach integrates technical refinement in side-to-side bypass with pragmatic contingency planning, enabling tailored revascularization based on intraoperative anatomical and technical feasibility.