The anterior interhemispheric trephine approach to anterior midline aneurysms: Results of treatment in 72 consecutive patients

Abstract

We report the results of a prospective study of an anterior interhemispheric trephine approach in 72 consecutive patients with aneurysms of the anterior communicating artery (64 cases) and anterior cerebral arteries (eight cases). The salient features of the operative technique include a limited forehead crease incision, low anterior frontal midline trephine (4 cm), unilateral dural opening (2.5 cm), opening up of the anterior interhemispheric fissure and exposure of aneurysm and anterior cerebral vessels by a phased dissection. The best anatomical orientation is retained without compromising the superior sagittal sinus, falx cerebri, left frontal cortical veins, or eloquent areas of the brain. The results (excellent to good recovery or mild to moderate disability in 87.5% of cases) confirm that the technique is safe and well tolerated even in the elderly or fragile patients.

Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures

“…12,18,19,27,35,48,49,56,57,69 Taking these series into consideration, without accounting for patients' preoperative status and despite the diversity of the criteria, the range of good results (GOS Scores 4 and 5) varied between 74 and 87.5%; excellent results rarely reached as high as 56.4% and the mortality rate lay between 3.5 and 6.8%. In our series, the proportion of excellent results was 65% in the overall population; however, the mortality rate was increased by 10.4%.…”

“…These combined morbidity and mortality rates could be monitored during discussions of ACoA aneurysm management with the patient's family. A review of surgical series of patients with ACoA aneurysms, 12,18,19,27,35,48,49,56,57,69 revealed that the main cause of unfavorable outcome appears to be the initial SAH with its deleterious consequences, specifically, direct brain damage, hydrocephalus, or vasospasm-related ischemia. In our series, SAH was related to unfavorable outcomes in both microsurgically treated groups (1990-1995 and 1996-2000); it was responsible for approximately an 8% combined rate of morbidity and mortality among patients with a good preoperative status and approximately a 55% rate among those with a poor preoperative status.…”

“…Advances in surgical techniques and the choice between interhemispherical and pterional approaches have greatly improved surgical results. 7,35,48,49,57,59,70 Since the advent of CT scanning, the combined morbidity and mortality rate of ruptured ACoA aneurysms has been estimated to range between 10 and 40%. 12,18,19,27,36,45,48,49,51,56,62,69 Moreover, the use of GDCs has led to several reports on the capacity of endovascular embolization to prevent aneurysm rebleeding during the acute stage of SAH 5,9,14,37,67 and its usefulness and integration in the therapeutic armamentarium against cerebral aneurysms.…”

Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients

“…A wide variety of approaches to the AComm region have been described,[79151820232533–3537384145–47] and our description of the subfrontal approach only differs from other reports in subtle ways, but these subtleties have made big differences in our practice. All of the approaches provide appropriate exposure and achieve satisfactory results.…”

“…[25–71118202123–25283236374448] It is important to emphasize that the purpose was not to create a minimally invasive exposure with limited access, but rather to tailor the pterional exposure and blend it with the subfrontal approach to this region to create a rapid, efficient and ample exposure for most AComm aneurysms. We present recent results in the patients treated through this approach because we are convinced that this exposure is similar to but more direct than the pterional approach, and offers an excellent option for rapid and adequate exposure and treatment of most AComm aneurysms.…”