[Some considerations on surgical approaches to the anterior communicating artery aneurysms--radiological study of 122...

We studied the operative approaches to anterior communicating artery aneurysms by means of reviewing preoperative angiogram and operation records. During the past 5 years, 117 patients with anterior communicating artery aneurysms were operated on in our hospital. Among these, we examined 112 cases of which preoperative angiogram and operation records were satisfactory for this study. We checked the next points on the preoperative angiograms. Neck of aneurysm-planum sphenoidal distance. Direction of the anterior communicating artery. It means which A2 is anterior to the other A2 in the lateral view of angiogram. Size of aneurysm. We checked the next points on the operation records. Operative approach and the side of craniotomy. When the pterional approach was taken, the rectal gyrus was aspirated or not. This analysis derived these two conclusions as below. 1. In the literature, as the operative approach to anterior communicating artery aneurysm, the pterional approach has a lot of advantages. For example, the pterional approach was accomplished without extensive frontal lobe retraction, without mobilization of the temporal lobe, without sacrificing the olfactory tract, and so on. Moreover, in early stage after onset of SAH, it is possible to remove the subarachnoid blood extensively without obvious brain damage by the pterional approach. In this study, we paid attention to the correlation between the neck-planum sphenoidal distance and the fact of aspiration of the rectal gyrus in the pterional approach. The result is that the higher aneurysmal neck was, the more frequently the rectal gyrus was aspirated. So, if the neck-planum sphenoidal distance is under 12 mm, which includes the majority of the cases (94% of cases), we think the pterional approach is the best approach for anterior communicating artery aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)