Microanatomical Study Of Anterior Communicating Artery And Its Perforating Arteries And Surgical Treatment Of Anterior Communicating Artery Aneurysms

Objective: To anatomise and measure anterior communicating artery (ACoA)and its perforating arteries under the operative microscope, we expect to provideuseful anatomic data for neurosurgeons. In order to improve the diagnostic andtherapeutic level of the anterior communicating artery aneurysms, the clinicaldata of 309 patients with anterior communicating artery aneurysms weresummarized and the different management strategies of it were discussed,including craniotomy and endovascular embolization.Methods: 1. In order to obtain some important anatomic parameters forneurosurgeons and guide the procedures of clinical operation, ACoA and itsperforating arteries were dissected and measured under microscope in 10formalin-fixed adult cadaver heads, the adjacent structures, blood supplying and theirvariations were also recorded.2. A retrospective analysis of the clinical data of 309patients with anterior communicating artery aneurysms, treated from January 2002to January 2007 in Tianjin Huanhu Hospital, was performed. The imagingdiagnosis, treatments, the timing of operation and the cure ofcomplications were summarized.Results: 1. In the anatomic study of ACoA and its perforating arteries, 10branches of ACoA were found in 10 formalin-fixed adult cadaver heads. A normalACoA, defined as the artery connecting the right and left anterior cerebral arteries (ACAs) through a single lumen, was found in 8 cadaver brains (80%). In theremaining 2 cadaver brains (20%), anomalies were observed. They included fusion in1 (10%) cadaver brain and duplication in 1 (10%). The direction of ACoA includedtow types, left to right (80%) and front to back (20%). ACoA were just over the opticchiasm in 9 (90%) and on the optic chiasm in 1 (10%). The middle of ACoA directthe center of optic chiasm in 8 (80%) and direct the rear edge of optic chiasm in 2(20%). The position of ACoA slant from the left in 4 (40%) and locate center in 6(60%). The perforating branches were observed in all cadaver brains. These littlebranches always originated from the posterior, superior or the inferior wall of theACoA, however, none of them originate from the anterior wall of ACoA. Thesubcallosal branch was found in 3 cadaver brain (30%).2. The clinical data show that 309 patients with anteriorcommunicating artery aneurysms were divided into craniotomy group (n=118)and endovascular embolization group (n=181). Their postoperativecomplications and the result Glasgow outcome scale (GOS) score wereevaluated at discharge. In the craniotomy group, 95 patients had betteroutcomes based on GOS score at discharge, 17 had poorer outcomes, and6 died. In the endovascular embolization group, 148 patients had betteroutcomes, 24 had poorer outcomes, and 9 died. Among 309 patients, 10patients gave up operation because of poor economic condition.Conclusion: According to the anatomic study of ACoA and its perforatingarteries, we can verify that ACoA has more variation of morphology and itsperforating arteries have the important vascular territory. ACoA is the predilectionsite of intracranial aneurysms. The damage of ACoA and its perforating arteries willgive rise to the severe postoperative complication. It is essential that weshould understand the brain vascular anatomy and variation of morphology sufficiently. The reasonable timing of operation and the cure ofcomplications is the key to improve the surgical outcome of anteriorcommunicating artery aneurysms.