Direction Of Anterior Communicating Artery Aneurysm And Clipping Treatment Of Craniotomy

Objective:The most common site of intracranial aneurysms is in the Willis ring of the brain.Subarachnoid hemorrhage?SAH?occurs when ruptured aneurysms occur.In recent years,the incidence of anterior communicating artery aneurysms has been increasing year by year.Because of the complex anatomical structure of anterior communicating artery and the frequent occurrence of hemodynamic changes,the aneurysms in this location have varied directions,disordered shapes and often ruptured and bleeding problems^[1].At the same time,the periphery of the operation is densely covered with key perforating vessels,which significantly increases the difficulty of the operation.Therefore,in all aneurysms surgery,it is the most difficult and risky.For such patients,the current clinical use of intracranial aneurysm clipping surgery to treat^[2].The purpose of this study is to explore the relationship between the intracranial anatomical characteristics of anterior communicating artery aneurysms and the surrounding tissues and the surgical techniques according to the direction of aneurysms,and to compare and analyze the therapeutic effects,so as to reduce the mortality of patients,control complications,and optimize the prognosis of patients.Methods:This paper summarizes and studies the imaging characteristics,aneurysm orientation and carotid anatomy skills of 159 patients with this disease treated in our hospital from September 2016 to September 2018.Aneurysm direction is based on the patient's brain CT angiography?Computed tomographic,?for reference:the anterior communication and the two sides of the A2 segment are set as a reference plane,so as to create a coordinate system,the X axis is parallel to the anterior communicating artery,and the Y axis is parallel to the two sides of the A2 segment.According to the different directions of the aneurysms,the aneurysms can be divided into five types:anterior,inferior,posterior,upper and complex.According to the type of aneurysms and the general situation of patients,the relevant preoperative examinations were improved.All patients were treated by pterional approach for intracranial aneurysm clipping,and appropriate surgical techniques were selected according to the intraoperative conditions.The patients were followed up for 3to 6 months.The Glasgow Outcome Scale?GOS?was used to evaluate and compare the outcomes of the patients.SPSS18.0 software was used for statistical analysis of the data,and the P value was greater than 0.05.There was no statistical significance.Results:According to the individual conditions of patients and the feedback of different aneurysm orientation from imaging data,the results were as follows:anterior orientation?62 cases?,inferior orientation?25 cases?,posterior orientation?20 cases?,superior orientation?37 cases?and complex orientation?15 cases?.The incidence of aneurysm direction was 40%,16%,12%,23%and9%respectively.Among them,there were 143 patients with grade I-III and 16patients with grade IV-V.There were 146 Fisher stage I-II patients,10 Fisher stage III patients and 3 Fisher stage IV patients.The diameter of aneurysms was less than 3 mm in 128 patients,between 3 and 10 mm in 22 patients,and more than 10 mm in 9 patients.All patients underwent craniotomy and clipping of aneurysms.All patients were followed up for 3 to 6 months.The results showed that no aneurysm recurrence occurred in all patients.The GOS score was?4 to 5 points?in 142 cases,?2 to 3 points?in 12 cases and?5 cases?in 1 point.Individual differences in the treatment of patients after craniotomy were compared,the difference was small,there was no statistical significance?P>0.05?.Conclusion:There was no significant difference?P>0.05?between patients with different anterior communicating artery aneurysms after craniotomy.So for our neurosurgeons,for the treatment of anterior communicating artery aneurysm,we should choose the appropriate surgical treatment according to the specific direction of the anterior communicating artery aneurysm and the individual difference of the patient's condition,and the study found that the patients who received craniotomy and clipping had fewer complications,better curative effect,significantly improved the cure rate of aneurysm,and at the same time.It is concluded that among the five types of anterior communicating artery aneurysms,the highest incidence is anterior type.This can not only reduce the occurrence of surgical complications,but also reduce the side effects of surgery and improve the prognosis of patients.