The Surgical Intervention Of The Ruptured Aneurysmof ACoA

Background Anterior communicating artery(ACoA)is the most favorable site for occurence of aneurysm,aneurysm of ACoA(ACoA-AN)compromise of 25%-30% intracranial aneurysm.Except for a few cases,patients with ACoA-AN haven't obvious symptom before rupture of the aneurysm and result in low rate of accurate diagnosis before stroke caused by aneurysmal rupture.Patient with ruptured ACoA-AN present with subarachnoid hemorrhage with/without intracerebral and intraventricular hematoma.Because of deep location,variant direction of aneurysmal dome and many perforators,more risk exist in microsurgical clipping of ACoA-AN than aneurysm of internal carotid-posterior communicating artery and middle cerebral artery;on the other hand,embolization is also difficult because long pathway and curve should be across in artery.Therefore,it is very important to evaluate surgical curative effect according to properties of ACoA-AN and then guild option of operative mothods.Materials and Methods 80 patients fit to the acceptance standard deal发t with microsurgical clipfrom Jan.2002 to Jun.2008 were analyzed retrogradly,and the cases were divided into clipping group(microsurgical clip)and embolization group (endovasecular embolization)according to different operative mothod.The curative effect was compared in different situation(size,width of neck,preoperative CT features and operative time)between two group.Neurological function was evaluated by Glascow outcome scale(GOS). Results No statistical significant difference in Hunt-Hess grading and GOS exist between clip group and embolization group.The incidence of intra-operative rupture of aneurysm and post-operative infarct in patients with subarachnoid hemorrhage companied with intracerebral hematoma were obvious higher than in pure subaranoid hemorrhage.To the aneurysm's diameter＞3mm or presented with only subarachnoid hemorrhage in CT scan,post-operative infarct in embolization group is obvious more than clip group.In clip group,there were more post-operative infarct in subacute phase than in acute and delayed group;but in embolization group,same post-operative infarct occurred in subacute phase and acute phase.Besides,2 cases treated with embolization occurred postoperative hemorrhage in our group.No correlation between intra-operative aneurismal rupture and prognosis,but post-operative infarct and hemorrhage were significant correlated with patients' GOS in six months after departing from hospital.Conclusion The size,width of neck of ACoA-AN,pre-operative CT features and what phase for operation are very important for operative option.Incidence of post-operative infarct after embolization is lower than clip,and embolization will be the first choice to patient with pure subarachnoid hemorrhage,diameter of aneurysm＞3mm, esp.in subacute phase.Perhaps,microsurgical clip is the better option for patients with subarachnoid hemorrhage companied with intracerebral hematoma.