Anterior communicating artery aneurysms

The anterior communicating artery (Acomm) is one of the most common locations for intracranial aneurysm (IA) formation, especially ruptured IAs. These lesions may vary greatly in anatomy and in complexity, and this combination of tortuous proximal anatomy, multiple branching and perforating arteries, and relatively small aneurysm sizes along with the potential for profound neurological and neuropsychological deficits secondary to vascular injury make AComm aneurysms a treatment challenge for even the most experienced of practitioners. Numerous microsurgical and endovascular techniques have been used to treat Acomm aneurysms, and there is no standard algorithm to follow. In this chapter, we will review the many endovascular and microsurgical treatment options as well as the nuances that may guide treatment choice.