Prognostic factors influencing outcome in unruptured anterior communicating artery aneurysm after microsurgical clipping

Abstract

Anterior communicating artery (A.com. A) aneurysm projection is an important factor in determining the outcome of aneurysm clipping. The objective of this study was to analyze the outcome of A.com.A aneurysm projection and prognostic factors influencing it and comparing them with Glasgow outcome scale. A retrospective analysis of 47 patients from hospital records who have got admitted in the Banbuntanke Hotokokai Hospital, Nagoya, Japan, from 2014 to 2017, with unruptured A.com.A aneurysm and subsequently operated in the hospital. Demographic factors such as age, sex, and associated with other aneurysms and the morphological characteristics such as aneurysm size, projection, and height were analyzed with postoperative complications and Glasgow outcome scale. Totally 47 cases have been operated in which 26 (55.3%) are female and 21 (44.6%) are male, and the median age is 68 years, 7 (14.89%) patients had middle cerebral artery aneurysm along with A.com.A aneurysm and 1 had internal carotid artery-posterior communicating artery junction aneurysm. Four (8.5%) had chronic subdural hematoma and 1 (2.12%) had epilepsy, 1 (2.12%) case got reoperated, and 1 (2.12%) had hydrocephalus. Moreover, the overall complication rate is 14.89%. For six patients, motor-evoked potential monitoring was used. Forty-six patients had Glasgow outcome scale of 5 and 1 patient had Glasgow outcome scale of 4. There was no mortality in this study. Mean size of the aneurysm was 6.68 mm and the range was 2–25 mm. Mean height was 4.14 mm, 26 (56.52%) A.com.A aneurysm were anteriorly projecting, 9 (19.56%) were superiorly projecting, 8 (17.32%) were inferiorly projecting, and 3 (6.38%) were posteriorly projecting. Morphological parameters such as size, height, and projection were not only highly associated with A.com.A aneurysm rupture and also complications due to clipping of aneurysm.

Role of preoperative computed tomography angiographic anatomical considerations and their intraoperative interpretations in prediction of outcome in microsurgical clipping of ruptured anterior communicating aneurysm

“…On their study, Kasinathan et al had most intra-and postoperative complications with anterior and inferior projection. In relation to outcome, anterior, superior, and posterior projecting aneurysms had good results of 93.7%, 91.8%, and 88.4%, respectively, while patients with inferiorly projecting aneurysms had only 79.2% good results [14,15]. Kasinathan et al studied variations of A1 segment (including dominance of the A1 segment, as well as hypoplasia and absence of an A1 segment) in outcome of Acom aneurysm clipping and it had a direct relationship to postoperative anterior cerebral artery ischemia [14].…”

Impact of Virtual Reality in Arterial Anatomy Detection and Surgical Planning in Patients with Unruptured Anterior Communicating Artery Aneurysms

“…Role of 3D-VR models in the selection of patient positioning and surgical approach: The aim of microneurosurgical management of ACoA aneurysms is total occlusion of the aneurysm sac with preservation of flow in all branching and perforating arteries [ 45 ]. To achieve this objective, it is important to consider aneurysm-related factors such as neck width and shape, wall calcifications, and branching vessels, as well as approach-related factors such as patient positioning, and location and extent of craniotomy [ 13 ].…”

Postoperative Infarction After Clipping of Unruptured Anterior Communicating Artery Aneurysms: Anatomical Consideration and Type of Infarction Territory

“…However, most of the studies included ruptured ACoAAs, which may cause di culty in the analysis of patients' characteristics and anatomical considerations independently because there may be a bias with variables that are generated from subarachnoid hemorrhage (SAH), such as brain swelling, vasospasm, and increased intracranial pressure (IICP) [6, 22,24,45,46,53,70]. In contrast, studies which included only unruptured ACoAAs did not evaluate the postoperative infarction or its risk factors speci cally [30,36,44,49]. This study is aimed to evaluate the risk factors and clinical outcome of postoperative infarction after surgical clipping of an unruptured ACoAA.…”