Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
World Neurosurg. 2020 Jun;138:e579-e590. doi: 10.1016/j.wneu.2020.03.005. Epub 2020 Mar 9.
The interhemispheric approach (IHA) provides an excellent surgical corridor for clipping anterior communicating artery aneurysms (AcoAAs). However, an important disadvantage of the approach is obtaining proximal control at A1 in the last stage of dissection, especially in anterior or superior projecting AcoAAs and ruptured cases. We describe and evaluate the microsurgical clipping of AcoAAs using the IHA with early A1 exposure.
This was a retrospective descriptive study in patients with AcoAA who received microsurgical clipping through the IHA with early A1 exposure between April 2016 and May 2019. Aneurysm morphology, projection, completeness of clipping, surgical complications, and outcomes were collected from medical records.
Twenty-five patients with AcoAA received microsurgical clipping via the IHA with early A1 exposure. Twenty-three patients (92%) presented with subarachnoid hemorrhage. Intraoperative rupture while dissecting the interhemispheric fissure occurred in 2 cases, for which proximal control via subfrontal route was effectively performed. Of the patients, 100% achieved complete obliteration of their aneurysms. Postoperative anosmia was detected in 22.7%. In ruptured cases, 16 (88.9%) of the good grade patients achieved a good outcome (Glasgow Outcome Scale scores of 4 and 5) at 3 months after the operation.
The IHA with early A1 is safe and effective for clipping AcoAAs.
额底纵裂入路（IHA）为夹闭前交通动脉动脉瘤（AcoAA）提供了极好的手术入路。然而，该入路的一个重要缺点是在最后阶段的分离中获得 A1 近端控制，尤其是在前部或上部突出的 AcoAA 和破裂的情况下。我们描述并评估了使用额底纵裂入路早期暴露 A1 夹闭 AcoAA 的显微手术。
这是一项回顾性描述性研究，纳入了 2016 年 4 月至 2019 年 5 月期间接受通过额底纵裂入路早期暴露 A1 显微手术夹闭 AcoAA 的患者。从病历中收集了动脉瘤形态、突出度、夹闭完整性、手术并发症和结果。
25 例 AcoAA 患者通过额底纵裂入路早期暴露 A1 接受了显微手术夹闭。23 例（92%）患者表现为蛛网膜下腔出血。术中在分离侧裂时发生 2 例动脉瘤破裂，通过额下入路有效进行了近端控制。所有患者的动脉瘤均达到 100%完全闭塞。术后嗅觉丧失发生率为 22.7%。在破裂的病例中，16 例（88.9%）良好分级患者在术后 3 个月获得良好结局（格拉斯哥预后量表评分 4 或 5）。
IHA 联合早期 A1 暴露安全有效，可用于夹闭 AcoAA。
