Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture

Abstract

The aim of this study is to evaluate the efficacy of microsurgical clipping of anterior communicating artery (AComA) aneurysms as a method of prevention of repeated aneurysm rupture. Materials and methods. A total of 98 patients were included in the study, with a mean age of 47.8 ± 11.0 years. The female-to-male ratio was 1.04 : 1.00. Aneurysms were verified using computer tomography of the head and neck vessels, selective cerebral angiography, and MRI angiography of cerebral vessels. Results. Pterional access was used for surgical intervention in all patients. In the first three days after the aneurysm rupture, microsurgical treatment was performed on 18 of the most severe patients. After three days and later, surgical intervention was performed in patients with compensated and sub-compensated conditions. Patients were further examined; microsurgical tactics were carefully planned. Brain compression, pronounced dislocation, and occlusive hydrocephalus were indications for emergency surgery. Angiospasm was detected in 45 patients (45.9 %), among them pronounced angiospasm was detected in 36 %, widespread – in 20 %, intracerebral hematomas – in 30 (30.6 %), intraventricular hemorrhages – in 28 (28.6 %). In five cases, intracerebral hematomas led to pronounced compression of the brain and dislocation of the middle structures. These patients underwent hematoma removal and aneurysm clipping. Half of the patients had simultaneous intraventricular hemorrhages and intracerebral hematomas of the frontal lobes and the blood was most often localized in several ventricles. Four patients with decompensated hydrocephalus underwent ventricular drainage and CSF bypass operations before aneurysm clipping. Postoperative mortality in this group of patients was 11 %, and severe neurological deficits were 22 %. It was established that repeated ruptures of AComA aneurysms occurred in 15 % of treated patients after admission to the hospital. Conclusions. Microsurgical treatment provides a minimally invasive approach that minimizes damage to the surrounding brain tissue and helps preserve brain function and minimizes the risk of postoperative neurological complications.