Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
J Clin Neurosci. 2010 May;17(5):592-6. doi: 10.1016/j.jocn.2009.09.024. Epub 2010 Mar 12.
We investigated surgical results based on craniotomy sidedness in patients with superiorly projecting anterior communicating artery (ACoA) aneurysms to evaluate decision-making on the surgical approach based on the anatomical planes of both A2 vessels. Among 99 patients treated surgically, 19 (19.2%) ACoA aneurysms projected superiorly. We analyzed the associations between surgical outcomes and the planes containing both A2 vessels (anterior or posterior displacement of A2 in relation to the aneurysm). Surgery in nine patients was approached from the side of the A2 posterior displacement, while surgery for ten patients was approached from the side of anterior displacement. A higher requirement for gyrus rectus aspiration was found in patients approached from the plane of A2 anterior displacement (p=0.041). All aneurysms were successfully secured without any surgery-related complications, except in two patients. Approaches from the side of posterior displacement of A2 in patients with superiorly projecting ACoA aneurysm allowed the aneurysmal necks to be secured safely and prevented postoperative complications.
我们研究了基于前交通动脉（ACoA）动脉瘤向上突出的侧颅切开术的手术结果，以评估基于 A2 血管解剖平面的手术入路决策。在 99 例接受手术治疗的患者中，有 19 例（19.2%）ACoA 动脉瘤向上突出。我们分析了手术结果与包含 A2 血管的平面（相对于动脉瘤的 A2 血管前后移位）之间的关系。在 9 例患者中，手术从 A2 后移位的一侧进行，而在 10 例患者中，手术从前移位的一侧进行。从前移位的 A2 血管平面进行手术的患者需要更多的直回抽吸（p=0.041）。所有动脉瘤均成功固定，无任何手术相关并发症，除 2 例患者外。对于 ACoA 动脉瘤向上突出的患者，从 A2 后移位侧进行手术可以安全地固定动脉瘤颈部，并预防术后并发症。
