(searched for: doi:10.1016/j.wneu.2020.12.100)
Neurosurgery, Volume 90; https://doi.org/10.1227/neu.0000000000001948
Neurosurgery, Volume 89; https://doi.org/10.1093/neuros/nyab134
Cureus, Volume 13; https://doi.org/10.7759/cureus.14927
Anterior communicating artery (ACOM) aneurysm clipping with intraoperative measures to ensure total occlusion and avoid ischemic complications is standard in countries such as the United States. However, alternatives need to be considered in resource-limited settings. The clipping of an unruptured, superiorly projecting ACOM aneurysm in a resource-limited setting is presented and special nuances that optimize safety are described. Careful surgical technique, meticulous identification of relevant anatomy, post-ligation inspection of the aneurysm and adjacent vessels, and possibly needle puncture of the aneurysm dome are critical to achieve favorable results.