The Art of Sharp Perianeurysmal Dissection and Controlled Bipolar Dome Reshaping in Microsurgical Clipping of Complex Anterior Communicating Artery Aneurysms

The authors present a surgical video demonstrating the nuanced technique of sharp perianeurysmal dissection and controlled bipolar dome reshaping in the microsurgical clipping of a broad-based anterior communicating artery (Acom) aneurysm. Traditional clipping strategies often fall short in cases with complex morphology, particularly when the aneurysm neck is obscured or the dome is multilobulated. In this video, we present such a case of a 42-year-old World Federation of Neurosurgical Societies Grade I gentleman with a 32 mm broad-based, multilobulated Acom aneurysm which was managed with sharp dissection and dome reshaping with bipolar forceps using low bipolar coagulation settings (10–15 W) which reduced dome volume by 30% enabling single-clip obliteration. This case highlights the role of precise arachnoid microdissection, judicious use of temporary clips and meticulous bipolar coagulation for aneurysm dome remodelling, allowing safe and effective neck delineation. The final construct achieved complete aneurysm obliteration with an excellent clinical outcome.