Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Postoperative Clipping Status after a Pterional versus Interhemispheric Approach for High-Positioned Anterior Communicating Artery Aneurysms

  • Kim, Myungsoo (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Kim, Byoung-Joon (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Son, Wonsoo (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, School of Medicine, Kyungpook National University)
  • Received : 2020.07.24
  • Accepted : 2020.10.07
  • Published : 2021.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : When treating high-positioned anterior communicating artery (ACoA) aneurysms, pterional-transsylvian and interhemispheric approaches are both viable options, yet comparative studies of these two surgical approaches are rare. Accordingly, this retrospective study investigated the surgical results of both approaches. Methods : Twenty-four patients underwent a pterional approach (n=11) or interhemispheric approach (n=13), including a unilateral low anterior interhemispheric approach or bifrontal interhemispheric approach, for high-positioned ACoA aneurysms with an aneurysm dome height >15 mm and aneurysm neck height >10 mm both measured from the level of the anterior clinoid process. The clinical and radiological data were reviewed to investigate the surgical results and risk factors of incomplete clipping. Results : The pterional patient group showed a significantly higher incidence of incomplete clipping than the interhemispheric patient group (p=0.031). Four patients (36.4%) who underwent a pterional approach showed a postclipping aneurysm remnant, whereas all the patients who experienced an interhemispheric approach showed complete clipping. In one case, the aneurysm remnant was obliterated by coiling, while follow-up of the other three cases showed the remnants remained limited to the aneurysm base. A multivariate analysis revealed that a pterional approach for a large aneurysm with a diameter >8 mm presented a statistically significant risk factor for incomplete clipping. Conclusion : For high-positioned ACoA aneurysms with a dome height >15 mm and neck height >10 mm above the level of the anterior clinoid process, a large aneurysm with a diameter >8 mm can be clipped more completely via an interhemispheric approach than via a pterional approach.

Keywords

References

  1. Alexander MP, Freedman M : Amnesia after anterior communicating artery aneurysm rupture. Neurology 34 : 752-757, 1984 https://doi.org/10.1212/WNL.34.6.752
  2. Benke T, Koylu B, Delazer M, Trinka E, Kemmler G : Cholinergic treatment of amnesia following basal forebrain lesion due to aneurysm rupture--an open-label pilot study. Eur J Neurol 12 : 791-796, 2005 https://doi.org/10.1111/j.1468-1331.2005.01063.x
  3. Birknes JK, Hwang SK, Pandey AS, Cockroft K, Dyer AM, Benitez RP, et al. : Feasibility and limitations of endovascular coil embolization of anterior communicating artery aneurysms: morphological considerations. Neurosurgery 59 : 43-52; discussion 43-52, 2006 https://doi.org/10.1227/01.NEU.0000219220.25721.B9
  4. Diraz A, Kobayashi S, Toriyama T, Ohsawa M, Hokama M, Kitazama K : Surgical approaches to the anterior communicating artery aneurysm and their results. Neurol Res 15 : 273-280, 1993 https://doi.org/10.1080/01616412.1993.11740148
  5. 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) 143 : 885-891, 2001 https://doi.org/10.1007/s007010170018
  6. Fontanella MM, Bergamasco L, Perozzo P, Priano L, Vighetti S, Griva F, et al. : Neuropsychological and neurophysiological evaluation after anterior communicating artery (ACoA) aneurysm surgery. J Neurosurg Sci 44 : 61-66; discussion 66-67, 2000
  7. Fujitsu K, Sekino T, Sakata K, Kawasaki T : Basal interfalcine approach through a frontal sinusotomy with vein and nerve preservation. Technical note. J Neurosurg 80 : 575-579, 1994 https://doi.org/10.3171/jns.1994.80.3.0575
  8. 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 38 : 325-328, 1996 https://doi.org/10.1097/00006123-199602000-00017
  9. Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF : Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery 50 : 550-555; discussion 555-557, 2002 https://doi.org/10.1227/00006123-200203000-00023
  10. Guglielmi G, Vinuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R : Endovascular treatment of 306 anterior communicating artery aneurysms: overall, perioperative results. J Neurosurg 110 : 874-879, 2009 https://doi.org/10.3171/2008.10.JNS081005
  11. Hayashi N, Sato H, Akioka N, Kurosaki K, Hori S, Endo S : Unilateral anterior interhemispheric approach for anterior communicating artery aneurysms with horizontal head position--technical note. Neurol Med Chir (Tokyo) 51 : 160-163, 2011 https://doi.org/10.2176/nmc.51.160
  12. Hedman AM, van Haren NE, Schnack HG, Kahn RS, Hulshoff Pol HE : Human brain changes across the life span: a review of 56 longitudinal magnetic resonance imaging studies. Hum Brain Mapp 33 : 1987-2002, 2012 https://doi.org/10.1002/hbm.21334
  13. Hernesniemi J, Dashti R, Lehecka M, Niemela M, Rinne J, Lehto H, et al. : Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol 70 : 8-28; discussion 29, 2008 https://doi.org/10.1016/j.surneu.2008.01.056
  14. 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) 32 : 136-139, 1992 https://doi.org/10.2176/nmc.32.136
  15. Ito Z : The microsurgical anterior interhemispheric approach suitably applied to ruptured aneurysms of the anterior communicating artery in the acute stage. Acta Neurochir (Wien) 63 : 85-99, 1982 https://doi.org/10.1007/BF01728859
  16. Joo MS, Park DS, Moon CT, Chun YI, Song SW, Roh HG : Relationship between gyrus rectus resection and cognitive impairment after surgery for ruptured anterior communicating artery aneurysms. J Cerebrovasc Endovasc Neurosurg 18 : 223-228, 2016 https://doi.org/10.7461/jcen.2016.18.3.223
  17. 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 73 : 688-690, 2010 https://doi.org/10.1016/j.wneu.2010.02.064
  18. Kempe LG, VanderArk GD : Anterior communicating artery aneurysms. Gyrus rectus approach. Neurochirurgia (Stuttg) 14 : 63-70, 1971
  19. Keogh AJ, Sharma RR, Vanner GK : The anterior interhemispheric trephine approach to anterior midline aneurysms: results of treatment in 72 consecutive patients. Br J Neurosurg 7 : 5-12, 1993 https://doi.org/10.3109/02688699308995050
  20. Kikuchi K, Watanabe K : Modified bifrontal interhemispheric approach to aneurysms of the anterior communicating artery with the use of a trephine craniotomy. A review of personal experience with 25 cases. Acta Neurochir (Wien) 125 : 127-131, 1993 https://doi.org/10.1007/BF01401839
  21. Kim BM, Park SI, Kim DJ, Kim DI, Suh SH, Kwon TH, et al. : Endovascular coil embolization of aneurysms with a branch incorporated into the sac. AJNR Am J Neuroradiol 31 : 145-151, 2010 https://doi.org/10.3174/ajnr.A1785
  22. Kim H, Kim TS, Joo SP, Moon HS : Pterional-subolfactory approach for treatment of high positioned anterior communicating artery aneurysms. J Cerebrovasc Endovasc Neurosurg 15 : 177-183, 2013 https://doi.org/10.7461/jcen.2013.15.3.177
  23. Lawton MT : Seven Aneurysms: Tenets and Techniques for Clipping. New York : Thieme Medical Publishers, Inc., 2011, pp94-120
  24. Long X, Liao W, Jiang C, Liang D, Qiu B, Zhang L : Healthy aging: an automatic analysis of global and regional morphological alterations of human brain. Acad Radiol 19 : 785-793, 2012 https://doi.org/10.1016/j.acra.2012.03.006
  25. Lubicz B, Lefranc F, Levivier M, Dewitte O, Pirotte B, Brotchi J, et al. : Endovascular treatment of intracranial aneurysms with a branch arising from the sac. AJNR Am J Neuroradiol 27 : 142-147, 2006
  26. Mavaddat N, Sahakian BJ, Hutchinson PJ, Kirkpatrick PJ : Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery. J Neurosurg 91 : 402-407, 1999 https://doi.org/10.3171/jns.1999.91.3.0402
  27. Moret J, Pierot L, Boulin A, Castaings L, Rey A : Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils. Neuroradiology 38 : 800-805, 1996 https://doi.org/10.1007/s002340050352
  28. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. : Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 98 : 959-966, 2003 https://doi.org/10.3171/jns.2003.98.5.0959
  29. O'Connor MG, Lafleche GM : Retrograde amnesia in patients with rupture and surgical repair of anterior communicating artery aneurysms. J Int Neuropsychol Soc 10 : 221-229, 2004 https://doi.org/10.1017/S1355617704102087
  30. Park J, Hamm I : Anterior interhemispheric approach for distal anterior cerebral artery aneurysm surgery: preoperative analysis of the venous anatomy can help to avoid venous infarction. Acta Neurochir 146 : 973-977, 2004
  31. Park J, Son W, Goh DH, Kang DH, Lee J, Shin IH : Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms. J Neurosurg 124 : 720-725, 2016 https://doi.org/10.3171/2015.1.JNS141766
  32. Proust F, Martinaud O, Gerardin E, Derrey S, Leveque S, Bioux S, et al. : Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg 110 : 19-29, 2009 https://doi.org/10.3171/2008.3.17432
  33. Ravnik J, Starovasnik B, Sesok S, Pirtosek Z, Svigelj V, Bunc G, et al. : Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J 47 : 253-263, 2006
  34. Sindou M, Auque J : The intracranial venous system as a neurosurgeon's perspective in Cohadon F (ed) : Advances and Technical Standards in Neurosurgery. New York : Springer, 2000, Vol 26, pp131-216
  35. Srour A, el Tantawi AM, Khouja N, Zouaoui A, Lassau JP, Philippon J, et al. : Neurosurgical anatomy of the anterior interhemispheric approach for aneurysms of the anterior communicating artery (26.6.92). Surg Radiol Anat 16 : 117-119, 1994 https://doi.org/10.1007/BF01627935
  36. Stenhouse LM, Knight RG, Longmore BE, Bishara SN : Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery. J Neurol Neurosurg Psychiatry 54 : 909-914, 1991 https://doi.org/10.1136/jnnp.54.10.909
  37. Suzuki J, Mizoi K, Yoshimoto T : Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg 64 : 183-190, 1986 https://doi.org/10.3171/jns.1986.64.2.0183
  38. Wright RA, Boeve BF, Malec JF : Amnesia after basal forebrain damage due to anterior communicating artery aneurysm rupture. J Clin Neurosci 6 : 511-515, 1999 https://doi.org/10.1016/S0967-5868(99)90013-9
  39. Yasui N, Nathal E, Fujiwara H, Suzuki A : The basal interhemispheric approach for acute anterior communicating aneurysms. Acta Neurochir (Wien) 118 : 91-97, 1992 https://doi.org/10.1007/BF01401292
  40. Yeh H, Tew JM Jr : Anterior interhemispheric approach to aneurysms of the anterior communicating artery. Surg Neurol 23 : 98-100, 1985 https://doi.org/10.1016/0090-3019(85)90327-1