Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation

Abstract

circulation (1-3). As indicated in many previous studies AcomA anatomy shows variability. Mean length of AComA is between 2-3 mm with an average diameter of 1.6 mm was reported (1-3). The most common location of the intracranial aneurysms is the ABSTRACT Purpose: The purpose of this study is to compare the pterional approach and the anterior interhemispheric approach for enabling a better surgical maneuverability. We describe the ideal the anatomic limitations of this surgery for anterior communicating artery aneurysms. Methods: Four formalin-fixed and silicone injected human heads were used for each approach. Möller 20-1000 microscope (Wedel, Germany) was used for dissection and all the photographs were obtained at a similar angle to the surgical microscope, with Canon EOS Rebel T5 Digital SLR Digital Camera with an EF 100mm f/2.8L Macro IS USM Lens and a Canon MR-14EX II Macro Ring Lite Flash (Canon Inc., Ohta-ku, Tokyo, Japan). Our dissection includes anterior interhemispheric and pterional approach with gyrus rectus resection and posterolateral orbitotomy. Results: Pterional approach was performed followed by the gyrus rectus resection and posterolateral orbitotomy. This area can be exposed by the 1x1 cm resection of the gyrus rectus. Subpial resection from posterior part of gyrus rectus is required. Posterolateral orbitotomy was performed and the orbital roof was removed. The anterior interhemispheric approach allows better visualization of the anterior and inferior surface of anterior communicating artery, A1-A2 junction and the optic nerve. Conclusions: We believe that the pterional approach combined with gyrus rectus resection and posterolateral orbitotomy is more suitable for anterior, posterior and inferior type anterior communicating artery aneurysms. Also, anterior interhemispheric approach can be considered as safer route for superior and high positioned type.