Surgical approaches to the anterior communicating artery aneurysm and their results

In the past 12 years, 102 cases of anterior communicating artery aneurysm have been operated upon in our institution. Two basic microsurgical approaches (pterional and interhemispheric) were used. The combined pterional and interhemispheric approach was performed in a few cases. The rational for each surgical approach is discussed in relation to anatomical factors such as the height of the aneurysm neck, the side of dominance of A1, the relationship between the bilateral proximal parts of A2s, and the projection of the aneurysm. The final outcome was correlated to the preoperative clinical grading and timing of surgery. The overall results were as follows; 82.4% good, 5.9% fair, 4.9% poor, and 6.8% mortality rate. The operative results for pterional and interhemispheric approach were comparable with each other. In the combined approach, we got poorer results which could be related to excessive brain retraction and unfavourable clinical grading.