Chen Junhui, Wu Ting, Zhang Chunlei, Hu Xu, He Jianqing, Zhang Hongqi, Wang Yuhai
Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China.
Department of Cardiology, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China.
World Neurosurg. 2025 Mar;195:123695. doi: 10.1016/j.wneu.2025.123695. Epub 2025 Feb 21.
We explored the impact of various craniotomy approaches on the outcomes and long-term cognitive function of microsurgical clipping for superiorly projecting anterior communicating artery (ACoA) aneurysms.
We retrospectively analyzed 127 superiorly projected ACoA aneurysms that underwent microsurgical clipping between January 2014 and January 2022. Patients were categorized into 2 types: type 1 (n = 70), characterized by the posterior positioning of the ipsilateral A2 segment (open A2 plane side); and type 2 (n = 57), characterized by the anterior positioning of the ipsilateral A2 segment (closed A2 plane side). The analysis focused on clinical outcomes (modified Rankin Scale score) and long-term cognitive function (Montreal Cognitive Assessment).
No significant differences in initial attributes were observed between the 2 groups. No differences were found in modified Rankin Scale score (P = 0.483), cognitive impairment (P = 0.190), or severe cognitive impairment (P = 0.332) between the 2 groups. Furthermore, no significant differences in delayed cerebral ischemia (P = 0.852), delayed bleeding (P = 0.912), or intraoperative rupture (P = 0.141) was found between the 2 groups. However, the occurrence of Montreal Cognitive Assessment subcategories of postponed memory items (P < 0.05) and conceptualization items (P < 0.05) demonstrated a significant decrease on the accessible A2 plane side during a shorter operative time (P = 0.03) and reduced gyrus rectus aspiration frequency (P < 0.001).
The anterior position of the A2 segment can offer better visualization of the aneurysm dome, bilateral A2, and AcoA, leading to reduced operative time and gyrus rectus aspiration frequency, potentially enhancing long-term cognitive function.
我们探讨了各种开颅手术入路对向上突出的前交通动脉（ACoA）动脉瘤显微夹闭术的疗效及长期认知功能的影响。
我们回顾性分析了2014年1月至2022年1月期间接受显微夹闭术的127例向上突出的ACoA动脉瘤。患者分为2型：1型（n = 70），其特征为同侧A2段位于后方（开放A2平面侧）；2型（n = 57），其特征为同侧A2段位于前方（闭合A2平面侧）。分析重点为临床疗效（改良Rankin量表评分）和长期认知功能（蒙特利尔认知评估）。
两组之间在初始特征方面未观察到显著差异。两组在改良Rankin量表评分（P = 0.483）、认知障碍（P = 0.190）或严重认知障碍（P = 0.332）方面均未发现差异。此外，两组在迟发性脑缺血（P = 0.852）、迟发性出血（P = 0.912）或术中破裂（P = 0.141）方面也未发现显著差异。然而，蒙特利尔认知评估中延迟记忆项目（P < 0.05）和概念化项目（P < 0.05）的发生率在开放A2平面侧在较短手术时间（P = 0.03）和减少直回抽吸频率（P < 0.001）的情况下显示出显著降低。
A2段位于前方可更好地显露动脉瘤瘤顶、双侧A2和ACoA，从而缩短手术时间并降低直回抽吸频率，可能会改善长期认知功能。
