In Situ Rescue Bypass for Iatrogenic Avulsion of Parent Artery during Clipping Large Pericallosal Artery Aneurysm

A case of large aneurysm arising from the distal end of an azygous A2 segment is presented. Multiple clip application inadvertently tore the aneurysmal neck, resulting in near avulsion of a right pericallosal artery origin. After an unsuccessful attempt to repair the avulsion, it was treated by occlusion of the origin of the pericallosal artery and an A4-A4 anterior cerebral artery in situ bypass without neurological deficits. The surgical technique and previous reports on side-to-side in situ bypass are discussed.