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It is possible only with a light-weight selfretaining retractor to feel the pressure being used for retraction. Experience is necessary before one can tell the safety limit for the retracting force. Generally, of course, the retractor is placed on the whitish portion of the body with thicker wall; a portion with a thin red wall must not be retracted. Another rule of thumb is that as the size of an aneurysm increases, the body will tolerate stronger retraction. 46 Anterior Communicating Artery Aneurysm Case 16 Temporary Clipping (rt) This 58-year-old man suffered an SAH 2 days before the operation.
The proximal portion of the body was resected, but total removal of the aneurysm was abandoned because of strong adhesion of the distal body to the normal brain. The postoperative course was uneventful and the patient recovered fully. Comment. This was an unusual aneurysm with no distal parent artery. Probably the distal artery had been embolized and had become organized. On the preoperative angiogram many fine collateral circulating arteries were found in the territory of the right anterior cerebral artery.
A right frontotemporal craniotomy was made as usual. The approach to the aneurysm was not started anteriorly to the aneurysm but posteriorly to the anterior communicating artery, so as to identify the parent arteries first. All four parent arteries and perforators were isolated. The main body was found projecting into the prechiasmatic cistern and it was tightly adherent to the surrounding tissues. A daughter dome was located over the anterior communicating artery pro- jecting toward the surgeon.