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Partially thrombosed anterior communicating artery aneurysm mimicking a suprasellar tumor: Microsurgical reconstruction after aneurysmotomy and ultrasonic thrombectomy

Year: 2026

Type: article

Abstract: Background: 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.

Source: Surgical Neurology International

DOI: 10.25259/sni_783_2026