Side selection of pterional approach for anterior communicating artery aneurysms – surgical anatomy and strategy

Abstract

This policy provided good postoperative outcomes. However, use of skull base techniques or the interhemispheric approach, instead of the normal pterional approach, may further improve the postoperative outcome for closed A2 plane aneurysms.

Anterior Communicating Artery Complex Aneurysms: Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases

“…This provides a better view of both A2 branches and the superiorlyprojecting aneurysm in between the branches. 26 Suzuki et al 27 approached superiorlyprojecting aneurysms from the side of the fundus projection. These authors identified a distinct group of patients with superiorly-projecting aneurysms characterized by a closed A2 plane who suffered from a higher rate of surgical complications such as vascular injury and cerebral contusion.…”

Anatomical variations of the anterior communicating artery complex: gender relationship

“…There is still a need to further explore the anatomy of the anterior cerebral circulation. The results of such studies would be useful when planning surgical approaches [ 25 ], and would allow to avoid any unexpected anatomical variations during treatment of ACoA aneurysms. Such anatomical problems may include double fenestrations of the A2 segment mimicking an aneurysm neck [ 18 ] or mistaking a duplicated A1 segment for an ACoA aneurysm [ 31 ].…”

Retrospective Analysis of Prognosis of Superiorly Projecting Anterior Communicating Artery Aneurysm with Respect to Position of A2 Anterior Cerebral Artery

“…In the cases of aneurysms directed posteroinferiorly and back of neck, entry into the side of the A2 located more anteriorly is recommended. Suzuki et al 12 showed the higher requirements gyrus rectus aspiration, higher incidence of residual neck remnant in closed A2 plane (p <0.0001) but no significant difference in associated vascular injury. There is significant difference in contusion was observed in patients with closed A2 plane.…”