Korean J Cerebrovasc Surg.  2011 Sep;13(3):249-255.

The Clinical Analysis of Anterior Communicating Artery Aneurysm Based on the Direction of Aneurysm

Affiliations
  • 1Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea. chwachoi@pusan.ac.kr

Abstract

OBJECTIVE: It has been known that the prognosis of aneurysm rupture is depend on the preoperative clinical state, presence of rebleeding, vasospasm, hydrocephalus, but the direction of aneurysm might be one of the important prognostic factors in the anterior communicating artery (ACOM) aneurysm.
METHODS
One hundred forty three cases of ACOM aneurysms, operated from 1996 to 2005, were analysed retrospectively according to the surgical outcomes and directions of aneurysms. RESULT: The results of analysis were summarized as follows 1) The direction of ACOM aneurysms were as follows; anterior-superior direction in 33.6%, anterior-inferior 30.1%, posterior-superior 10.5%, anterior 7.7%, superior 7.0%, inferior 7.0% and posterior-inferior in 4.2%. 2) There was no significant relationship between the direction of aneurysm and the preopertive clinical state, but the incidence of Hunt-Hess grade IV and V was high in the posterior-superior and anterior-superior direction groups. 3) Intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) was accompanied in 28.7%. In posterior-superior and anterior-superior direction group, there is statistically significance between direction and IVH or ICH (p < 0.05). 4) Vasospasm was observed in 23.8% and cerebral infarction in 17.5%. The incidence was increased in the posterior-superior group. 5) Superior and posterior-superior direction group showed high mortality rate (20.0%).
CONCLUSION
Although there was no statistic significance, we found that the direction of aneurysm might affect the clinical characteristics and prognosis in the patients underwent clipping surgery of ACOM aneurysm. Especially, posterior-superior and anterior-superior direction groups revealed the high incidence of ICH, IVH, vasospasm and cerebral infarction. Therefore, we should pay more careful attention to the patients with the superiorly directed ACOM aneurysms.

Keyword

Anterior communicating artery; Aneurysm; Direction
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