Clinical Study On Clipping Ruptured Anterior Communicating Artery Aneurysms Via The Opposite Side Of The Dominant A1 Pterion Approach

Objective:Compare the advantages and disadvantages of the opposite side of the dominant A1 Pterion approach craniotomy and the dominant side A1 Pterion approach craniotomy to clip the ruptured anterior communicating aneurysm.Methods:This study is a single center and retrospective study.The clinical data of 58patients with ruptured anterior communicating aneurysm with A1 anterior cerebral artery dominant signs of craniotomy in Jiangxi people’s Hospital from September 1,2013 to September 31,2019 were collected.According to the surgical approach,32patients were divided into two groups:the opposite side of the dominant A1 Pterion approach craniotomy group and 26 cases with the dominant A1 side Pterion approach craniotomy group.All patients were operated by the same neurosurgery group.The patients were followed up for one year.The patients’sex,age,operation time under microscope,clipping mode(simple clipping,complex clipping),3 months after operation and 1 year after operation were reviewed for DSA(aneurysm residue and recurrence),GOS score and other prognosis indexes in 1 year after operation.And statistical analysis,with P<0.05 as statistically significant,compared the advantages and disadvantages of two groups of different craniotomy methods.Results:1.General information:There was no statistically significant difference between the two groups in data comparison of male and female composition,age(P>0.05).2.Operation time under microscope:the operation time under microscope was1.57±0.32h in the opposite side of the dominant A1 Pterion approach craniotomy group and 1.63±0.37h in the dominant A1 side Pterion approach craniotomy group.3.Clipping method:there were 25 cases of simple clipping and 7 cases of complex clipping in the opposite side of the dominant A1 Pterion approach craniotomy group,12 cases of simple clipping and 7 cases of complex clipping in the dominant A1 side Pterion approach craniotomy group,with statistical significance(X~2=6.35,P<0.05).4.Residual or recurrent aneurysms after operation:in the opposite side of the dominant A1 Pterion approach craniotomy group,2 cases(6.25%)had residual or recurrent aneurysms 3 months after operation,and 3 cases(9.38%)had residual or recurrent aneurysms 1 year after operation;in the dominant A1 side Pterion approach craniotomy,2 cases(7.69%)had residual or recurrent aneurysms 3 months after operation,and 2 cases(7.69%)had residual or recurrent aneurysms 1 year after operation.5.GOS score:the good prognosis rate was 91.3%in the opposite side of the dominant A1 Pterion approach craniotomy craniotomy group and 95.5%in the dominant A1 side Pterion approach craniotomy group.Conclusions:There was no significant difference in the clinical effect between the opposite side of the dominant A1 Pterion approach clipping craniotomy and the dominant A1side Pterion approach clipping craniotomy for ruptured anterior communicating artery aneurysms,but it could facilitate the exposure process of the aneurysm neck and simplify the clipping method.