Research Article
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Year 2021, Volume: 5 Issue: 1, 70 - 77, 26.02.2021
https://doi.org/10.30621/jbachs.854242

Abstract

References

  • References 1. Hernesniemi J, Dashti R, Lehecka M, Niemela M, Rinne J, Lehto H, et al. Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol. 2008;70(1):8-28; discussion 9.
  • 2. Perlmutter D, Rhoton AL, Jr. Microsurgical anatomy of anterior cerebral anterior communicating recurrent artery complex. Surg Forum. 1976;27(62):464-5.
  • 3. Yasargil MG. Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984. 5-168 p.
  • 4. Sekhar LN, Natarajan SK, Britz GW, Ghodke B. Microsurgical management of anterior communicating artery aneurysms. Neurosurgery. 2007;61(5 Suppl 2):273-90: discussion 90-2.
  • 5. Kim SY, Jeon HJ, Ihm EH, Park KY, Lee JW, Huh SK. Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms. Clin Neurol Neurosurg. 2015;137:62-6.
  • 6. Andaluz N, Van Loveren HR, Keller JT, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery. 2003;52(5):1140-8; discussion 8-9.
  • 7. Yasargil MG. Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984. 169-224 p.
  • 8. Yun JK, Kang SD, Kim JM. Clipping of the Anterior Communicating Artery Aneurysm without Sylvian Fissure Dissection. J Korean Neurosurg Soc. 2007;42(5):388-91.
  • 9. 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 (Wien). 2001;143(9):885-91.
  • 10. Chaddad-Neto F, Doria-Netto HL, Campos-Filho JM, Ribas ES, Ribas GC, Oliveira E. Head positioning for anterior circulation aneurysms microsurgery. Arq Neuropsiquiatr. 2014;72(11):832-40.
  • 11. Yasargil MG. Microneurosurgery. Stutgart: Georg Thieme Verlag; 1984. 217-20 p.
  • 12. Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms. Neurosurgery. 2001;48(4):780-5; discussion 5-6.
  • 13. Dunker RO, Harris AB. Surgical anatomy of the proximal anterior cerebral artery. J Neurosurg. 1976;44(3):359-67.
  • 14. Kawashima M, Rhoton AL, Jr., Tanriover N, Ulm AJ, Yasuda A, Fujii K. Microsurgical anatomy of cerebral revascularization. Part I: anterior circulation. J Neurosurg. 2005;102(1):116-31.
  • 15. Horikoshi T, Nukui H, Mitsuka S, Kaneko M. Partial resection of the gyrus rectus in pterional approach to anterior communicating artery aneurysms. Neurol Med Chir (Tokyo). 1992;32(3):136-9.
  • 16. Liu P, Pan L, An X, Ma L, Yang M. Effect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: report of 15 patients. Int J Clin Exp Med. 2015;8(2):1912-7.
  • 17. Kawashima M, Matsushima T, Sasaki T. Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy. J Neurosurg. 2003;99(3):517-25.
  • 18. Kim H, Kim TS, Joo SP, Moon HS. Pterional-subolfactory Approach for Treatment of High Positioned Anterior Communicating Artery Aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):177-83.
  • 19. Suzuki M, Fujisawa H, Ishihara H, Yoneda H, Kato S, Ogawa A. Side selection of pterional approach for anterior communicating artery aneurysms--surgical anatomy and strategy. Acta Neurochir (Wien). 2008;150(1):31-9; discussion 9.
  • 20. Kashimura H, Kubo Y, Ogasawara K, Kakino S, Yoshida K, Ogawa A. Easy dissection of the interhemispheric fissure for treatment of the anterior communicating artery aneurysm by the pterional approach. World Neurosurg. 2010;73(6):688-90.
  • 21. de Sousa AA. Tips to the dissection of the interhemispheric fissure for the treatment of the anterior communicating artery aneurysm through the pterional approach. World Neurosurg. 2010;73(6):624.
  • 22. Matano F, Murai Y, Mizunari T, Tateyama K, Kobayashi S, Adachi K, et al. Olfactory preservation during anterior interhemispheric approach for anterior skull base lesions: technical note. Neurosurg Rev. 2016;39(1):63-9.
  • 23. Suzuki J, Mizoi K, Yoshimoto T. Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg. 1986;64(2):183-90.
  • 24. Traynelis VC, Dunker RO. Interhemispheric approach with callosal resection for distal anterior cerebral artery aneurysms. Technical note. J Neurosurg. 1992;77(3):481-3.
  • 25. Mielke D, Mayfrank L, Psychogios MN, Rohde V. The anterior interhemispheric approach: a safe and effective approach to anterior skull base lesions. Acta Neurochir (Wien). 2014;156(4):689-96.
  • 26. Fujiwara H, Yasui N, Nathal-Vera E, Suzuki A. Anosmia after anterior communicating artery aneurysm surgery: comparison between the anterior interhemispheric and basal interhemispheric approaches. Neurosurgery. 1996;38(2):325-8.
  • 27. Hernesniemi J, Ishii K, Niemela M, Smrcka M, Kivipelto L, Fujiki M, et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl. 2005;94:17-21.
  • 28. Kempe LG, VanderArk GD. Anterior communicating artery aneurysms. Gyrus rectus approach. Neurochirurgia (Stuttg). 1971;14(2):63-70.
  • 29. Hyun SJ, Hong SC, Kim JS. Side selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms. J Clin Neurosci. 2010;17(5):592-6.

Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation

Year 2021, Volume: 5 Issue: 1, 70 - 77, 26.02.2021
https://doi.org/10.30621/jbachs.854242

Abstract

Purpose: The purpose of this study is to compare the pterional approach and the anterior interhemispheric approach for enabling a better surgical maneuverability. We describe the ideal the anatomic limitations of this surgery for anterior communicating artery aneurysms.
Methods: 4 formalin-fixed and silicone injected human heads were used for each approach. Möller 20-1000 microscope was used for dissection and all the photographs were obtained at a similar angle to the surgical microscope, with Canon EOS Rebel T5 Digital SLR Digital Camera with a EF 100mm f/2.8L Macro IS USM Lens and a Canon MR-14EX II Macro Ring Lite Flash. Our dissection includes anterior interhemispheric and pterional approach with gyrus rectus resection and posterolateral orbitotomy.
Results: Pterional approach was performed followed by the gyrus rectus resection and posterolateral orbitotomy. This area can be exposed by the 1x1 cm resection of the gyrus rectus. Subpial resection from posterior part of gyrus rectus is required. Posterolateral orbitotomy was performed and the orbital roof was removed up to the superior orbital fissure. The anterior interhemispheric approach allows better visualization of the anterior and inferior surface of anterior communicating artery, A1-A2 junction and the optic nerve.
Conclusions: We believe the pterional approach combined with gyrus rectus resection and posterolateral orbitotomy, if needed, is more suitable for anterior, posterior and inferior type, with anterior interhemispheric approach being the safer for superior and high positioned anterior communicating artery aneurysms.

References

  • References 1. Hernesniemi J, Dashti R, Lehecka M, Niemela M, Rinne J, Lehto H, et al. Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol. 2008;70(1):8-28; discussion 9.
  • 2. Perlmutter D, Rhoton AL, Jr. Microsurgical anatomy of anterior cerebral anterior communicating recurrent artery complex. Surg Forum. 1976;27(62):464-5.
  • 3. Yasargil MG. Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984. 5-168 p.
  • 4. Sekhar LN, Natarajan SK, Britz GW, Ghodke B. Microsurgical management of anterior communicating artery aneurysms. Neurosurgery. 2007;61(5 Suppl 2):273-90: discussion 90-2.
  • 5. Kim SY, Jeon HJ, Ihm EH, Park KY, Lee JW, Huh SK. Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms. Clin Neurol Neurosurg. 2015;137:62-6.
  • 6. Andaluz N, Van Loveren HR, Keller JT, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery. 2003;52(5):1140-8; discussion 8-9.
  • 7. Yasargil MG. Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984. 169-224 p.
  • 8. Yun JK, Kang SD, Kim JM. Clipping of the Anterior Communicating Artery Aneurysm without Sylvian Fissure Dissection. J Korean Neurosurg Soc. 2007;42(5):388-91.
  • 9. 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 (Wien). 2001;143(9):885-91.
  • 10. Chaddad-Neto F, Doria-Netto HL, Campos-Filho JM, Ribas ES, Ribas GC, Oliveira E. Head positioning for anterior circulation aneurysms microsurgery. Arq Neuropsiquiatr. 2014;72(11):832-40.
  • 11. Yasargil MG. Microneurosurgery. Stutgart: Georg Thieme Verlag; 1984. 217-20 p.
  • 12. Heros RC, Fritsch MJ. Surgical management of middle cerebral artery aneurysms. Neurosurgery. 2001;48(4):780-5; discussion 5-6.
  • 13. Dunker RO, Harris AB. Surgical anatomy of the proximal anterior cerebral artery. J Neurosurg. 1976;44(3):359-67.
  • 14. Kawashima M, Rhoton AL, Jr., Tanriover N, Ulm AJ, Yasuda A, Fujii K. Microsurgical anatomy of cerebral revascularization. Part I: anterior circulation. J Neurosurg. 2005;102(1):116-31.
  • 15. Horikoshi T, Nukui H, Mitsuka S, Kaneko M. Partial resection of the gyrus rectus in pterional approach to anterior communicating artery aneurysms. Neurol Med Chir (Tokyo). 1992;32(3):136-9.
  • 16. Liu P, Pan L, An X, Ma L, Yang M. Effect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: report of 15 patients. Int J Clin Exp Med. 2015;8(2):1912-7.
  • 17. Kawashima M, Matsushima T, Sasaki T. Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy. J Neurosurg. 2003;99(3):517-25.
  • 18. Kim H, Kim TS, Joo SP, Moon HS. Pterional-subolfactory Approach for Treatment of High Positioned Anterior Communicating Artery Aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):177-83.
  • 19. Suzuki M, Fujisawa H, Ishihara H, Yoneda H, Kato S, Ogawa A. Side selection of pterional approach for anterior communicating artery aneurysms--surgical anatomy and strategy. Acta Neurochir (Wien). 2008;150(1):31-9; discussion 9.
  • 20. Kashimura H, Kubo Y, Ogasawara K, Kakino S, Yoshida K, Ogawa A. Easy dissection of the interhemispheric fissure for treatment of the anterior communicating artery aneurysm by the pterional approach. World Neurosurg. 2010;73(6):688-90.
  • 21. de Sousa AA. Tips to the dissection of the interhemispheric fissure for the treatment of the anterior communicating artery aneurysm through the pterional approach. World Neurosurg. 2010;73(6):624.
  • 22. Matano F, Murai Y, Mizunari T, Tateyama K, Kobayashi S, Adachi K, et al. Olfactory preservation during anterior interhemispheric approach for anterior skull base lesions: technical note. Neurosurg Rev. 2016;39(1):63-9.
  • 23. Suzuki J, Mizoi K, Yoshimoto T. Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg. 1986;64(2):183-90.
  • 24. Traynelis VC, Dunker RO. Interhemispheric approach with callosal resection for distal anterior cerebral artery aneurysms. Technical note. J Neurosurg. 1992;77(3):481-3.
  • 25. Mielke D, Mayfrank L, Psychogios MN, Rohde V. The anterior interhemispheric approach: a safe and effective approach to anterior skull base lesions. Acta Neurochir (Wien). 2014;156(4):689-96.
  • 26. Fujiwara H, Yasui N, Nathal-Vera E, Suzuki A. Anosmia after anterior communicating artery aneurysm surgery: comparison between the anterior interhemispheric and basal interhemispheric approaches. Neurosurgery. 1996;38(2):325-8.
  • 27. Hernesniemi J, Ishii K, Niemela M, Smrcka M, Kivipelto L, Fujiki M, et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl. 2005;94:17-21.
  • 28. Kempe LG, VanderArk GD. Anterior communicating artery aneurysms. Gyrus rectus approach. Neurochirurgia (Stuttg). 1971;14(2):63-70.
  • 29. Hyun SJ, Hong SC, Kim JS. Side selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms. J Clin Neurosci. 2010;17(5):592-6.
There are 29 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Ali Karadag

Publication Date February 26, 2021
Submission Date January 5, 2021
Published in Issue Year 2021 Volume: 5 Issue: 1

Cite

APA Karadag, A. (2021). Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation. Journal of Basic and Clinical Health Sciences, 5(1), 70-77. https://doi.org/10.30621/jbachs.854242
AMA Karadag A. Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation. JBACHS. February 2021;5(1):70-77. doi:10.30621/jbachs.854242
Chicago Karadag, Ali. “Microsurgical Management in Anterior Communicating Artery Aneurysms: An Anatomical Investigation”. Journal of Basic and Clinical Health Sciences 5, no. 1 (February 2021): 70-77. https://doi.org/10.30621/jbachs.854242.
EndNote Karadag A (February 1, 2021) Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation. Journal of Basic and Clinical Health Sciences 5 1 70–77.
IEEE A. Karadag, “Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation”, JBACHS, vol. 5, no. 1, pp. 70–77, 2021, doi: 10.30621/jbachs.854242.
ISNAD Karadag, Ali. “Microsurgical Management in Anterior Communicating Artery Aneurysms: An Anatomical Investigation”. Journal of Basic and Clinical Health Sciences 5/1 (February 2021), 70-77. https://doi.org/10.30621/jbachs.854242.
JAMA Karadag A. Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation. JBACHS. 2021;5:70–77.
MLA Karadag, Ali. “Microsurgical Management in Anterior Communicating Artery Aneurysms: An Anatomical Investigation”. Journal of Basic and Clinical Health Sciences, vol. 5, no. 1, 2021, pp. 70-77, doi:10.30621/jbachs.854242.
Vancouver Karadag A. Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation. JBACHS. 2021;5(1):70-7.