WILLPOWER MELTDOWN SOMETIMES

One way to improve surgical skill is to experience others’ surgeries as if they were your own. To achieve this, writing articles about surgeries performed by others is a good approach. This is a subarachnoid hemorrhage in a woman in her 60s caused by rupture of a distal anterior cerebral artery aneurysm. It was a relatively wide-necked, heart-shaped aneurysm that had also enlarged tangentially along the anterior cerebral artery. In other words, the entire neck had enlarged. The plan was to first occlude the tip, then occlude the lateral bleb, and finally occlude the base. If it were me, I would likely have chosen the larger A4 branch, placed a balloon, and then coiled it. In that case, catheter control would become difficult. There is a risk that coils might not enter the bleb, leaving residual blood flow in the bleb. Catheter control near the neck would be challenging, and there is a risk of coils migrating into the parent vessel.

Lesson Learned