Partially thrombosed anterior communicating artery aneurysm mimicking a suprasellar tumor: Microsurgical reconstruction after aneurysmotomy and ultrasonic thrombectomy
José Luis Quelho Filho, Pedro Henrique Argentato Brassarola, Paulo Eduardo Albuquerque Zito Raffa, Leonardo Vieira Nunes, Leonardo Peixoto Garcia, Rodrigo Shibaki, Lucas Crociati Meguins, Eberval Gadelha FigueiredoBackground:
Partially thrombosed intracranial aneurysms are uncommon lesions that may mimic intracranial neoplasms because of their heterogeneous radiological appearance and mass effect. When associated with broad-neck morphology and incorporation of adjacent vessels, treatment may require complex microsurgical reconstruction.
Case Description:
A 69-year-old woman with hypertension and type 2 diabetes mellitus underwent investigation after a mild traumatic brain injury. Initial computed tomography (CT) demonstrated a suprasellar lesion suggestive of a neoplastic process. CT angiography and digital subtraction angiography subsequently revealed a partially thrombosed anterior communicating artery aneurysm measuring 19 × 10 mm with a 6.6-mm neck and incorporation of the right A2 segment into the aneurysm neck. The patient underwent elective microsurgical treatment through a right fronto-orbital approach. Following temporary vascular control, aneurysmotomy and ultrasonic thrombectomy using the Clarity ® system were performed. Definitive reconstruction required sequential placement of eight permanent clips while preserving both A2 segments. Intraoperative fluorescein angiography confirmed adequate vessel patency. The patient remained neurologically intact, with a modified Rankin Scale score of 0 at 90-day follow-up.
Conclusion:
Partially thrombosed anterior communicating artery aneurysms may mimic suprasellar tumors and represent an important diagnostic challenge. In selected cases with branch incorporation, broad-neck morphology, and significant thrombotic burden, microsurgical reconstruction remains a safe and effective treatment strategy. Aneurysmotomy combined with ultrasonic thrombectomy facilitates visualization of the true aneurysm neck and may assist complex clip reconstruction.