Surgical management of giant anterior cerebral artery aneurysms

Giant aneurysms of the anterior cerebral artery are uncommon lesions that present unique surgical challenges. Although they occasionally rupture, they more frequently present with frontal lobe dysfunction, visual loss, hydrocephalus, and pituitary dysfunction secondary to mass effect. Successful surgical treatment is dependent upon a thorough preoperative evaluation and a careful operative plan. Neurosurgeons dealing with these complex lesions need to be prepared to utilize multiple surgical strategies including direct clip reconstruction, proximal ligation, trapping and excision, bypass or a combination thereof.