Dissecting aneurysms of the precommunicating segment anterior cerebral artery (ACA; A1 segment) are a rare cause of subarachnoid hemorrhage.1–9When they bleed, the dissected lesions are treated with direct surgery,1–3,6,7,9endovascular treatment,8 or medical management.5 Direct surgery enables surgeons to confirm the extent of the dissection and to verify the involvement of the branching arteries closely; however, in cases of subarachnoid hemorrhage, the presence of hematoma hinders identification of such vascular structures.
Indocyanine green videoangiography (ICG-VA) has been a useful intraoperative visual guidance in cerebrovascular surgery. Several prospective studies have evaluated the usefulness of ICG-VA in surgery for saccular aneurysm,10–13 but rarely in cases of dissecting aneurysms.14,15 Herein, we first reported the preclipping ICG-VA findings of a dissecting aneurysm from the A1 segment. The dissecting aneurysm appears as a unique fluorescent image on ICG-VA. In addition, ICG-VA helps us identify branching arteries even in the presence of hematoma.
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