{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:06:46Z","timestamp":1784887606833,"version":"3.55.0"},"reference-count":13,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Giant thrombosed anterior communicating artery (AComA) aneurysms represent a significant neurosurgical challenge with no consensus regarding their optimal management. It often requires an intraaneurysmal thrombectomy, which necessitates temporary inflow occlusion. This carries a substantial risk of ischemic complications. We report a case of a giant thrombosed AComA aneurysm that was successfully treated with clipping combined with intra-aneurysmal thrombectomy and an A3\u2013A3 bypass.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A 55-year-old man presented with temporal quadrantanopia of the right eye caused by a giant thrombosed AComA aneurysm compressing the optic nerve. To facilitate safe thrombectomy under temporary A1 occlusion, a side-to-side A3\u2013A3 bypass was constructed in advance to preserve distal anterior cerebral artery (ACA) perfusion and reduce the risk of ischemia. Intra-aneurysmal thrombectomy and definitive clipping were then performed.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n The aneurysm was successfully obliterated. Postoperatively, the patient showed improved visual function without frontal lobe deterioration or new neurological deficits.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Prophylactic A3\u2013A3 bypass provides critical distal ACA protection during the surgical management of giant thrombosed AComA aneurysms. This strategy may enhance surgical safety and reduce ischemic complications. A video of the surgical operation is presented, and the safety and reliability of the surgical procedure are discussed.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_493_2026","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:42:14Z","timestamp":1784886134000},"page":"416","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clipping of a giant thrombosed anterior communicating artery aneurysm with A3\u2013A3 bypass: A technical case report with 4K video"],"prefix":"10.25259","volume":"17","author":[{"given":"Hiroshi","family":"Matsufuji","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Tsunoda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Segawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiari","family":"Umakoshi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"10.25259\/SNI_493_2026\/ref-1","doi-asserted-by":"crossref","first-page":"e834","DOI":"10.1016\/j.wneu.2018.07.063","article-title":"Treatment of partially thrombosed intracranial aneurysms: Single-center series and systematic review","volume":"118","author":"G\u00fcresir","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_493_2026\/ref-2","doi-asserted-by":"crossref","first-page":"E110","DOI":"10.1093\/ons\/opz415","article-title":"Recurrent giant anterior cerebral artery (ACA) aneurysm with previous coiling, attempted clipping then direct ACA-to-ACA bypass: 2-dimensional operative video","volume":"18","author":"Hendricks","year":"2020","journal-title":"Oper Neurosurg"},{"key":"10.25259\/SNI_493_2026\/ref-3","doi-asserted-by":"crossref","first-page":"E47","DOI":"10.1093\/ons\/opaa052","article-title":"A3-A3 bypass for giant anterior cerebral artery aneurysm: 2-dimensional operative video","volume":"19","author":"Hendricks","year":"2020","journal-title":"Oper Neurosurg"},{"key":"10.25259\/SNI_493_2026\/ref-4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3171\/jns.2003.98.2.0407","article-title":"Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: The role of vasa vasorum. 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