Efficacy Of Microsurgical Management Of Anterior Communicating Artery Aneurysm

Objective: To assess the effect of microsurgical treatment for anterior communicatinganeurysm and analysis on the factors effecting it’s therapeutic thus to improve theprognosis.Methods: The data of128patients with anterior communicating artery aneurysmmicrosurgically managed via pterional approach between January2010and December2012in the department of neurosurgery, Sichuan Provincial People’s Hospital wasanalyzed retrospectively. All aneurysms were clipped successfully. When discharged fromthe hospital, Glasgow Outcome Scale (GOS) was applied to evaluate the prognosis of allpatients as with a good prognosis (GOS5-4) or a poor one (GOS3-1). Between these twogroups, the impact of the dome direction of the aneurysm, aneurysm size, operation timing,and preoperative Hunt-Hess grade was compared using Chi-square test (SPSS18.0).Results: According to the contrast examination, the dome directions of the aneurysm forthese128patients were divided into five types: anterior superior type28(21.87%), anteriorinferior type45(35.1%), posterior superior type16(12.5%), posterior inferior type34(26.56%), and complicated type5(3.91). Sizes of the ACoA:<5mm45(35.16%),5～15mm65(50.78%),15～25mm16(12.5%),≥25mm2(1.56%). By operation timing theywere divided into the early surgery group18(14.6%), the intermediate surgery group75(58.6%) and the late surgery group35(27.34%). Preoperative Hunt-Hess grades: I42(32.8%), II53(41.4%), III28(21.9%) and Ⅳ5(3.9%). The favorable prognosis rate ofthe superior type patients was77.28%, and that of the inferior type patients was87.34%.The difference is statistically significant (P<0.05). In terms of the sizes of the aneurysms,the favorable prognosis rates were88.89%,90.77%,37.5%and50%respectively, with astatistical significance (P<0.05). As for the operation timing, these rates were77.78%,80% and91.43%respectively, which is not statistically significant (P>0.05). The favorableprognosis rates were90.48%,86.79%,71.43%and40%, in terms of the Hunt-Hess gradesbut also without significant differences (P>0.05).Conclusion:1.Microsurgical management of anterior communicating artery aneurysmvia modified pterional approach was an effective methodology.2.The intraoperative fully revealing of the anterior communicating aneurysm, artery ofHeubner, perforating branch and ascertaining the anatomical relationship among theadjacent structures, were important to prognosis.3. The individualized excision of gyrus rectus plays an important role in intraoperativeexposure of the aneurysms, especially in regards to the anterior superior type, posteriorsuperior type and complicated type.4. According to our study, Hunt-Hess grades and operation timing are of no remarkableeffect on the prognosis.5. However, the dome direction of the aneurysm and the size of it would give us moreindication of the prognosis. The bigger the aneurysm is, the worse the prognosis would be.And in the inferior cases, the patients would likely to have a more favorable outcome thanthat of the superior ones.