The Eyebrow Approach to Anterior Communicating Artery Aneurysms

Sung, Seng Oun; Jeon, Byung Chan; Kim, Young Su; Kim, Il Sup

Abstract

OBJECTIVE
This study reviewed the clinical outcomes of patients with anterior communicating artery (AComA) aneurysms that were treated surgically using an eyebrow approach. The indications and limitations of this approach for the treatment of AComA aneurysms are also suggested.
METHODS
Between October 1999 and June 2006, 121 procedures were performed on 115 patients with 146 cerebral aneurysms via a superior orbital rim craniotomy through an eyebrow incision. Of them, 51 patients with AComA aneurysms were reviewed retrospectively according to the patient's age and gender, the Hunt-Hess grade upon admission, the Fisher grade of the subarachnoid hemorrhage, the size of the aneurysm, the direction of the aneurysmal sac, the outcome at 3-month follow-up period, complications and the intraoperative problems.
RESULTS
Overall, excellent and good outcomes were achieved in 47 patients (92.1%) and one patient died (2.0%). Clinically, there were 7 patients with a poor grade (Hunt-Hess grade 4); 3 showed a good outcome, 2 fair, 1 poor and 1 died. Premature rupture of the aneurysm during surgery occurred in 5 patients. One procedure was converted to the pterional approach due to severe brain swelling. Postoperative subdural fluid collection was noted in 9 patients, of whom 2 patients required temporary drainage and 1 patient needed a permanent subdural fluid diversion. Vasospasm and a subsequent infarction were observed in 4 patients. Hydrocephalus that required a ventriculoperitoneal shunt was found in only 2 patients.
CONCLUSIONS
The favorable indications for eyebrow surgery include good grade patients with a ruptured or unruptured AComA aneurysm, and patients with small and medium sized aneurysms. Furthermore, the poor grade or high Fisher grade patients with or without multiple concomitant aneurysms can also be treated with eyebrow surgery.