BRIEF NOTE
A artéria cerebral anterior bi-hemisférica é uma variante anatômica da artéria cerebral anterior. A presença de um aneurisma na artéria cerebral anterior distal com essa variante representa um desafio cirúrgico, pois a oclusão da artéria principal deve ser evitada a todo custo para prevenir isquemia do tecido cerebral distal. Diversas técnicas cirúrgicas têm sido empregadas no tratamento de aneurismas da artéria cerebral anterior distal. A abordagem pterional é considerada simples e eficaz, podendo fornecer os princípios fundamentais da clipagem de aneurismas, mesmo nos segmentos distais da artéria cerebral anterior. Este relato apresenta um caso raro de um paciente do sexo masculino, 83 anos, com artéria cerebral anterior bi-hemisférica e aneurisma no lado dominante do segmento A2. Utilizamos a abordagem pterional, que proporcionou controle proximal precoce e exposição adequada para avaliação da artéria principal. Conseguimos visualizar com sucesso a artéria principal, o colo do aneurisma e o segmento distal de A2. A clipagem foi realizada com êxito, mantendo o fluxo arterial aferente, avaliado por doppler transcraniano.
The bihemispheric anterior cerebral artery is a normal variant of the anterior cerebral artery. Aneurysm in the distal anterior cerebral artery with this variant presents a surgical challenge as parent artery occlusion must be avoided at any cost to prevent ischemia of the distal brain tissue. Several surgical procedures have been employed to treat distal anterior cerebral aneurysms. The pterional approach is considered a simple approach that can provide golden rules in aneurysm clipping even to the distal segment of the anterior cerebral artery. This report presents a rare case of an 83-year-old adult male with a bihemispheric anterior cerebral artery with aneurysm on the dominant side of the A2. We used the pterional approach that gives early proximal control and sufficient exposure to evaluate the parent artery. We successfully visualized the parent artery, neck of the aneurysm and the distal A2 segment. Successful clipping, achieved with patent efferent artery flow, was evaluated using transcranial doppler.
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1Neurosurgery Division, Department of Surgery, Faculty of Medicine, Sanglah General Hospital, Universitas Udayana, Bali, Indonesia
Received Jul 27, 2025
Accepted Aug 15, 2025
