Anterior Communicating Artery Aneurysms: Surgical Strategy and Outcome based on Proposed Newer Classification

Area of Science:

• Neurosurgery
• Vascular Neurology
• Cerebrovascular Disease

Background:

• Ruptured anterior communicating artery (Acom) aneurysms are common intracranial aneurysms.
• Surgical outcomes are influenced by patient age, time to intervention, and clinical grade.
• Acom aneurysms originate from the A1-A2-Acom junction or the Acom artery itself.

Purpose of the Study:

• To analyze surgical outcomes of ruptured Acom aneurysms.
• To evaluate a proposed classification system for Acom aneurysms based on site and morphology.
• To correlate aneurysm characteristics with clinical parameters and surgical prognosis.

Main Methods:

• Retrospective review of 250 ruptured Acom aneurysm cases.
• Classification of aneurysms by origin, morphology (Type I-III), and fundus direction (Type A-E).
• Statistical comparison of clinical parameters across aneurysm types using Fischer-exact and ANOVA tests.

Main Results:

• Type I Acom aneurysms were common, particularly with left A1 dominance.
• Significant differences in post-operative vasospasm were observed among aneurysm types.
• Anteriorly directed aneurysms (Type I) had a better prognosis than posteriorly directed ones (Type II, III).

Conclusions:

• Pre-operative classification by site, morphology, and direction aids surgical planning and prognosis.
• Junctional Type IA aneurysms are frequent and associated with high intra-operative rupture risk.
• Anteriorly directed aneurysms correlate with better outcomes, while visual complaints suggest anterior-inferior direction.