Abstract
Anterior communicating artery (ACoA) aneurysms are the most common aneurysm encountered in neurosurgical practice. They account for one-quarter to one-third of all mitreated aneurysms in the published medical literature. AcoA aneurysms tend to hemorrhage, frequently at or less than the size limits that are considered safe for conservative management. Moreover, they often hemorrhage in younger patients for whom microsurgical clipping might be preferred over endovascular coiling. Thus, neurosurgeons must be trained and ready to deal with these aneurysms. ACoA aneurysms, more than any other, present a remarkable spectrum of complexities and technical challenges that stem from variations in parent artery anatomy, aneurysm projection, and clinical presentation. In addition, the ACoA complex is adjacent to the hypothalamus, optic apparatus, and cognitive/emotional centers in the basal frontal lobes. Arteries that arise from the ACoA complex supply the basal ganglia, internal capsule, and motor/sensory cortex. Therefore, the surgical treatment of ACoA aneurysms is associated with increased risks of complications compared with aneurysms in other common anterior circulation locations, such as middle cerebral artery or posterior communicating artery aneurysms. This chapter discusses the techniques and dynamics that facilitate the surgical management of ACoA aneurysms and helps to improve patient outcomes.