Document Detail

Side selection of pterional approach for anterior communicating artery aneurysms--surgical anatomy and strategy.
MedLine Citation:
PMID:  18058058     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To evaluate our decision policy based on vertical aneurysm projection for selecting the side of the pterional approach for the surgical treatment of anterior communicating artery aneurysms. METHODS: Inferiorly projecting aneurysms were treated through the dominant A1 side, and superiorly projecting aneurysms were treated through the side of aneurysm fundus projection. We analysed postoperative outcome and surgical complications, and the correlations between the anatomical factors such as position (high or low), projection (dorsal or anterior), and the plane containing both A2 vessels (open A2 plane defined as the A2 of the approach side located more posteriorly than the contralateral A2; closed A2 plane as the ipsilateral A2 located more anteriorly than the contralateral A2), to assess the surgical requirements of approaches in patients with superiorly projecting aneurysms. FINDINGS: A favorable outcome was achieved in 95.1% of patients with inferior type aneurysms and 85.2% of patients with superior type aneurysms (P = 0.088). Surgical complications occurred in 8.9% of patients with inferior type aneurysms and 17.9% with superior type aneurysms. However, there was a distinct group of patients with superior type aneurysms characterised by a closed A2 plane, in which the ipsilateral A2 was located anterior to the contralateral A2, in whom the approach toward the neck was significantly more difficult, requiring A2 displacement or gyrus aspiration, and resulting in a neck remnant and more surgical complications such as vascular injury or cerebral contusion. This group also had a significantly high correlation with high position and dorsal projection of aneurysms causing more difficult dissection. CONCLUSIONS: This policy provided good postoperative outcomes. However, use of skull base techniques or the interhemispheric approach, instead of the normal pterional approach, may further improve the postoperative outcome for closed A2 plane aneurysms.
M Suzuki; H Fujisawa; H Ishihara; H Yoneda; S Kato; A Ogawa
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2007-12-07
Journal Detail:
Title:  Acta neurochirurgica     Volume:  150     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-03-12     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  31-9; discussion 39     Citation Subset:  IM    
Clinical Neuroscience, Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan.
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MeSH Terms
Aged, 80 and over
Aneurysm, Ruptured / surgery*
Glasgow Outcome Scale
Intracranial Aneurysm / classification,  radiography,  surgery*
Middle Aged
Multivariate Analysis
Neurosurgical Procedures / methods*
Regression Analysis
Treatment Outcome

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