Mini-anterior interhemispheric approach prioritizing preservation of the olfactory nerve function for unruptured anterior communicating aneurysm clipping.

Abstract

Background: Clipping through the interhemispheric (IH) approach is an effective treatment technique for anterior communicating artery (AcomA) aneurysms. It provides neurosurgeons with a wider surgical field, good visibility of perforating branches, and ease of securing parent vessels; however, it has several disadvantages. Thus, in this study, we reviewed the efficacy of surgical clipping using the mini-anterior IH (AIH) approach for AcomA aneurysms in preserving olfactory nerve function.

Methods: In this retrospective study, we evaluated the data of 12 consecutive patients with unruptured AcomA aneurysms who underwent surgical clipping using the mini-AIH approach between April 2012 and April 2025 at our hospital. We assessed the anatomical features of the aneurysms, complications associated with clipping, and surgical outcomes at the first visit after clipping.

Results: The median patient age, aneurysm size, dome/neck ratio, and operative time were 63 years, 5.6 mm, 1.3, and 188 min, respectively. No cases of opening of the frontal sinus, intraoperative rupture, or clipping-related complications were observed. We successfully clipped all aneurysms completely, and no patient developed anosmia after surgery. The postoperative modified Rankin scale score was 0 in all patients at their first visit to our clinic after surgery.

Conclusion: In the management of patients with unruptured cerebral aneurysms, the clipping technique should be evaluated in comparison to the minimally invasive nature and clinical outcomes of endovascular treatment.