Anterior Communicating Artery Complex Aneurysms: Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases.
OBJECTIVE
Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome.


METHODS
The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed.


RESULTS
Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations.


CONCLUSIONS
The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.
['Bohnstedt|Bradley N|BN|', 'Conger|Andrew R|AR|', 'Edwards|John|J|', 'Ziemba-Davis|Mary|M|', 'Edwards|Gary|G|', 'Brom|Jacqueline|J|', 'Shah|Kushal|K|', 'Cohen-Gadol|Aaron A|AA|']
D000328:Adult D000368:Aged D016208:Databases, Factual D057510:Endovascular Procedures D005260:Female D005500:Follow-Up Studies D006801:Humans D002532:Intracranial Aneurysm D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D012189:Retrospective Studies D013525:Surgical Instruments D016896:Treatment Outcome
Anterior communicating artery Clip ligation Anatomy Intracranial aneurysm Microsurgery Treatment outcome