Surgical Treatment Of The Anterior Communicating Aneurysms

It is reported that 30% of cerebral aneurysms arise from anterior communicating artery. It is one of the difficult sites in anterior Willis circle aneurysms. Location of the ACoA aneurysm often vary because of the complex anatomical varieties of the ACoA. There are many complicated structures around the ACoA aneurysms. All these reasons make the surgical treatment very difficult. It is very important to study the anatomy, classification, operative approach and postoperative complication of ACoA aneurysms. It is also very important for guiding surgical treatment, reducing complication and decreasing mortality rate.Objective: We studied the 40 cases of ACoA aneurysm patients treated in the neurosurgery department of the first hospital of Shan xi medical university from January 2001 to February 2006. We focus on the image characteristics, classification, operative approach, microanatomy and postoperative complication. We discussed not only the classification and surgical treatment of the ACoA aneurysm but also the best timing of surgery. Methods: All of the patients are made a definite diagnosis by cerebral angiography. The AcoA aneurysm are classified depending on the lateral image of cerebral angiography. They are anterior superior, anterior inferior, posterior superior, posterior inferior and complicated type. The patients receive the surgical treatment. The number of the approach of pterion or longitudinal fissure is respectively 20. The number of early, middle and delayed stage is respectively is 4, 14 and 22.Result: The aneurysms of 38 patients were clipped successfully. Two aneurysms were wrapped up. The postoperative complication were coma, cerebral infarct, hydrocephalus, intracerebral hematoma, electrolyte disturbances, psychiatric symptom, cerebrospinal fluid infection, anepia, visual disorder. The prognosis is evaluated by GOS grade. We combine anterior superior type with anterior inferior type, and rename this group as anterior type, the same way is done with posterior superior type and posterior inferior type, we rename it as posterior type. The percent of better prognosis of the anterior type is 92.8%, the one of the posterior type is 66.7%. The prognosis is statistically significant between the two groups (P<0.05). The percent of better prognosis of the approach of pterion is 90%, the one of longitudinal fissure is 80%. The prognosis is not statistically significant between the two groups (P>0.05). The percent of better prognosis in early , middle or delayed stage is 75% , 85.7% , or 86.4%. The prognosis is not statistically significant between the three groups (P>0.05).Conclusion:1. Clipping aneurysm by microsurgery is good treatment for the anterior communicating aneurysms.2. The anterior communicating aneurysms can be treated by the approach of both pterion and longitudinal fissure. The surgeon can make a decision to the alternative approach.