The Clinical Analysis of Microsurgical Treatment for Anterior Communicating Artery Aneurysm Via Pterional Approach

Objective To summarize treatment experiences of microsurgical clipping for anterior communicating artery aneurysm via pterional approach. Methods Clinical data of 82 cases undergoing microsurgical clipping for anterior communicating artery aneurysm via pterional approach in the first affiliated hospital of Kunming Medical University from October 2008 to December 2014 were collected and retrospectively analyzed.The patients were divided into different groups by Hunt-Hess illness grading scale,with 11 cases for level 0,7cases for level I, 30 cases for level II, 25 cases for level III, 8 cases for level IV, and 1 cases for level V.Twenty-one patients underwent operation at early stage of SAH(≤3d),15 at late stage of SAH(4d~2W),and35 at prolonged stage of SAH(>2W). The prognosis of patients was evaluated according to GOS classification criteria at discharge.Results A total of 85 ACo AA were found in 82 patients and all of them were clipped and,at the same time, 3 aneurysms were resected and 11 thrombuses were punctured, cut and removed. In the operation, 15(17.6%) aneurysms ruptured again and temporary blocking happened for 73 times, with the shortest blocking time of 2 min, the longest of 40 min, and the average of 9.26 min. According to GOS score, good recovery rate was 79.3%(65/82), moderate disability rate was 12.2%(10/82), severe disability rate was 3.7%(3/82), vegetative state rate was 0%, and death rate was 4.9%(4/82). Good recovery rates for the operations at early, late and prolonged stage of SAH were 85.7%, 73.3% and 82.3% respectively and for level 0 to level V were90.9%, 85.6%, 86.7% and 84.0%, 25.0% and 0.0% respectively. Results of DSA or CTA re-examination upon55 patients followed-up at discharge or three months after discharge showed that tumor pedicle were clipped and aneurysm disappeared. Fifty cases were followed up from four months to seven years after the operation, with one case of aneurysm recurrence. Another thirty-two cases were lost to follow-up. Conclusions Microsurgical techniques and microdissection are keys to successful operation. Pterional approach can guarantee successful clipping of aneurysms with different directions, locations and sizes. It is also an easy, effective and reliable approach with less postoperative complications. Operation for anterior communicating artery aneurysm should be performed as early as possible.