Analysis on the Early Surgical Results of Patients with Poor-grade Anterior Communicating Artery Aneurysms via Frontotemporal-transorbital Approach

Kim, Joo Young; Song, Jin Kyu; Jang, Suk Jung

Abstract

Anterior communicating artery aneurysm is located in the deep area of the brain base around the important midline structure. It has adjacent complex arterial anatomy and multidirectionally projected aneurysm fundus. For these reasons, various surgical approaches including anterior interhemispheric and pterional approaches to the anterior communicating artery aneurysm have been introduced, but none of them are thought to be completely adequate for large and complex anterior communicating artery aneurysm. In the acute stage when brain edema is very severe, poor-grade anterior communicating artery aneurysm is more difficult to treat surgically and represents higher morbidity and mortality. In our hospital, forty one patients with Hunt-Hess grade IV-V anterior communicating artery aneurysms were operated on via frontotemporal-transorbital approach within 72 hours after onset of subarachnoid hemorrhage from May 1, 1990 to April 30, 1996. The frontotemporal-transorbital approach was found to have many advantages in the surgery of these poor-grade anterior communicating artery aneurysms, i.e., providing multidirectional surgical dissection and aneurysmal viewing, mininal brain retraction, wider basal exposure, shortest distance to the lesion, and preservation of the nerve and vascular supply to the frontotemporal muscle. The results of the early surgery for poor-grade anterior communicating artery aneurysm via frontotemporal-transorbital approach represented reduced morbidity(31.7%) and mortality(22.0%).