J Korean Neurosurg Soc.  2002 Jun;31(6):551-557.

Clinical Outcome of Pterional Approach to the Anterior Communicating Artery Aneurysm Surgery According to Identification of H-Complex

• Kim JG
• Kim HD

Abstract

OBJECTIVE
In case of the anterior communicating artery(A-com A) aneurysm surgery with pterional approach, complete identification of A-com A complex(H-complex) has been thought to be important and influence the clinical results. The authors present a retrospetive analysis to determine the significance of identification of H-complex in A-com A surgery.
METHODS
We analysed 90 cases among 116 cases that were operated the A-com A aneurysm with pterional approach from June 1993 to May 1998. The cases were classified according to aneurysmal direction, size, and placement of A1-A2 junction by preoperative angiogram and intraoperative findings.
RESULTS
Incomplete visualization of H-complex was influenced by the approach side to the anteriorly placed A1-A2 junction, larger than 11mm in aneurysmal size and superior or posterior direction of aneurysm. Postoperative outcome was influenced by Hunt-Hess grade, and seemed to be better when the approach was performed to side of the posteriorly placed A1-A2 junction with or without dominant A1, but aneurysmal direction was not concerned with postoperative outcome.
CONCLUSION
The results suggest that in A-com A aneurysm surgery with pterional approach, careful evaluation of preoperative angiogram and approach to the side of the posteriorly placed A1-A2 junction lead to better outcome.

Keyword

Anterior communicating artery; Aneurysm H-complex; Pterional approach; junction; Postoperative outcome

MeSH Terms

Aneurysm
Intracranial Aneurysm*