Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating XXXX .

@entity1 @entity439 @entity438
OBJECTIVE: We investigated the effectiveness of a right hemispheric surgical approach in treating unruptured anterior communicating @entity438 . METHODS: Between January 2005 and June 2012, 305 @entity1 with anterior communicating artery (Acom) @entity439 were treated using the pterional approach. Among them, 113 who underwent microsurgery with an unruptured Acom @entity439 were enrolled in this study. Every @entity1 was evaluated with digital subtraction angiography preoperatively and CT scans were taken several times postoperatively. Surgical outcomes and complications were evaluated at discharge using the Glasgow Outcome Scale and at 6 months after surgery with CT angiography. RESULTS: Enrolled @entity1 included 55 males and 58 females with a mean age of 56.3 years (range: 30-75 years). The mean diameter of the @entity439 was 5.8mm (range: 1.9-24.1). Left A1 dominancy was found in 71 @entity1 (62.8%) whereas right A1 dominancy was found in 20 @entity1 (17.7%), and right pterional craniotomies were performed in 92 @entity1 (81.4%) while left pterional craniotomies were performed in 21 @entity1 (18.6%). Complete clip application was achieved in 94.9% of @entity1 (74 of 78) in right-side approach group but in only 81.3% of @entity1 (13 of 16) in left-side approach group. Despite a left A1 dominancy and approached from the right, more than 90% of the @entity1 had an excellent outcome at discharge (GOS 5) and more than 90% a complete @entity439 clipping at the 6-month follow-up CT angiography although it was not statistically significant. CONCLUSION: Microsurgical clipping of the unruptured Acom @entity439 through a right-side surgical approach showed favorable postoperative clinical and anatomical outcomes, especially @entity439 smaller than 10mm.
