Case Report: Microsurgical clipping of a multilobular fenestrated anterior communicating artery aneurysm: technical challenges with video analysis

The complexity of the AComA anatomy in this case prompted reflection on the limitations of preoperative imaging and the need for careful intraoperative planning. Although advanced imaging modalities, particularly three-dimensional rotational angiography, are crucial for detecting vascular anomalies, ultra-thin bridging vessels may remain undetected, as occurred in this case. Intraoperative recognition of these structures required real-time adaptation to ensure safe dissection and successful aneurysm clipping To our knowledge, this is the first operative video documenting microsurgical clipping of an unruptured aneurysm within a fenestrated AComA. This case underscores the importance of anticipating anatomical variations and adapting surgical strategies to optimize outcomes in complex cerebrovascular procedures.