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Clipping of the Anterior Communicating Artery Aneurysm without Sylvian Fissure Dissection

Yun, Ji-Kwang    (Department of Neurosurgery School of Medicine, Institute of Wonkwang Medical Science Wonkwang University Hospital   ); Kang, Sung-Don    (Department of Neurosurgery School of Medicine, Institute of Wonkwang Medical Science Wonkwang University Hospital   ); Kim, Joon-Moon    (Department of Neurosurgery School of Medicine, Institute of Wonkwang Medical Science Wonkwang University Hospital  );
  • 초록

    Objective : The focus of aneurysm surgery is eliminating unnecessary operative manipulations and preparing the surgeon for any crises that might arise. With this concept in mind, we have tried resection of the gyrus rectus without routine sylvian fissure dissection in selected patients with anterior communicating artery (ACom) aneurysms, and compared these results with those from the conventional transsylvian approach. Methods : This retrospective study included 231 surgically treated patients with ACom aneurysms from March, 1997 to May, 2005. The patients were divided into two groups : Group A (96 with sylvian fissure dissection, March, 1997-December, 2000) and Group B (135 without sylvian fissure dissection, January, 2001-May, 2005). Overall surgical outcomes were compared, and operative times have been prospectively recorded since January, 04 to evaluate how this maneuver affected the length of surgical procedures. Results : All aneurysms were satisfactorily clipped, and there was no evidence of increased number of procedure-related retraction injuries in group B. Overall outcome was good in 186 (80.5%); 76 (79.2%) in group A, and 110 (815%) in group B ( $x^2$ test, p=0.79). In good clinical grade of group A, good outcome was observed in 60 patients (89.6%) and in group B, 97 patients (94.2%) (Fisher's exact test, p=0.38) (Fig. 2). Conclusion : In this study, eliminating the step of sylvian fissure dissection by gentle lateral basal-frontal retraction to the side of the sylvian fissure did not increase morbidity and mortality. However, we do not intend to modify the standard approach to the ACom aneurysm that is familiar to and has been mastered by many others. Rather, we report our experience on the basis of our anatomic understanding of the technique and its results.


  • 주제어

    Anterior communicating artery .   Aneurysm .   Sylvian fissure .   Dissection.  

  • 참고문헌 (10)

    1. Aydian IH, Kadioglu HH, Tuzun Y, Kayaoglu CR, Tuzun E, Ozturk M : Postoperative anosmia after anteior communicating artery aneurysms surgery by the pterional approach. Minim Invasive Neurosurg 39 : 71-73, 1996 
    2. Hoeoek O, Norlen G : Aneurysms of the anterior communicating artery. Acta Neurol Scand 40: 219-240, 1964 
    3. Wen HT, Antonio CM, Rhoton AL : Surgical Anatomy of the Brain: Youmans Neurological surgery 5rh. ed. Saunders Co., 2004, Vol l, pp7 
    4. Grand W, Landi MK, Dare AO : Transorbital keyhole approach to anterior communicating artery aneurysms. Neurosurgery 49 : 483-484, 2001 
    5. El-Noamany H, Nakagawa F, Hongo K, Kakizawa Y, Kobayashi S : Low anterior interhemispheric approach-a narrow corridor to aneurysms of the anterior communicating artery. Acta Neurochir 143 : 885-891, 2001 
    6. Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Siwanuwatn R, et al : Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex. Neurosurgery 56: 397-405, 2005 
    7. Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, er al : Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. J Neurosurg 99 : 13-14, 2003 
    8. Andaluz N, Van Loveren HR, Keller JT, Zucearello M : Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery 52 : 1140-1148, 2003 
    9. Solomon RA : Anterior communicating artery aneurysm. Neurosurgery 48: 119-123, 2001 
    10. Yasargil M : Microneurosurgery. Stuttgart: Thieme Stratton, 1984, Vol 1, pp36-39 

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