Microneurosurgical Treatment Of Anterior Communicating Artery Aneurysms

Objective:To investigate the anatomy features of anterior communicating artery aneurysms and anterior communicating artery complex, operation time and surgical techniques for the aneurysms, and the prevetion of complications.Methods:144anterior communicating artery aneurysms patients with158aneurysms underwent microneurosurgery in Tongji hospital affilicated Huazhong university of science and technology from2010.3to2012.3. Of the158aneurysms,151were clipped,7were wrapped.1was accompanied with cerebellar arteriovenous malformation.103patients received temporary occlusion of the parental arteries and lamina terminalis fenestration was performed in35cases. Chi-square test (the software was SAS8.1) was used to analysis the effect of operation time, preoperative grading of Hunt-Hess, and the age of patients on the prognosis.Results:This series included144patients,76males and68females aged22-74years (mean51years), and12.5%(18cases) was more than60years old. There were49,55,29,6,5cases in terms of the preoperative grading of Hunt-Hess respectively from I to V. The patients were divided into (not randomly) early surgery group, the intermediate group, and the late surgery group (early group day1-3postictus, intermediate group day4-10, late group day11-21), the proportion is12.5%,45.8%and41.7%respectively. Surgical outcomes at hospital discharge were assessed using the Glasgow outcome score (GOS), GOS score4and5means favourable prognosis. There was no statistically significant difference in GOS score4and5between the surgical timing groups (GOS score4and5:66.7%,83.3%, and88.3%respectively; P>0.05, Chi-square test). The percentage of favourable outcomes was95.9%,92.7%,55%respectively in preoperative grading of Hunt-Hess â… ,â…¡, â…¢-â…¤. Of them, there was statistically significant difference (P<0.05). Outcome was favourable in77.8%of patients over60years, and84.1%in those under60, without statistically significant difference (P>0.05).Conclusion:1. Microsurgical clipping is an effective treatment for ruptured anterior communicating artery aneurysms.2. Pterional approach from the dominant side of blood supply for the aneurysma is conductive to temporary clip of parent arteries, which can decrease the risk of aneurysms immature rupture.