557 Results of Microsurgical Clipping of Unruptured Anterior Communicating Artery Aneurysms (ACOMa) Using the Pretemporal Minimal Durotomy Approach

Abstract

INTRODUCTION: Recent reports suggest the superiority of microsurgical clipping of ACOMa compared to endovascular treatments. We present our experience with the pretemporal minimal durotomy (minimal brain exposure) approach in 168 patients. METHODS: Data of 168 patients were prospectively collected and retrospectively reviewed. The pretemporal approach with the removal of the posterior roof of the orbit and the anterior clinoid process with a minimized subfrontal durotomy allowed broad exposure to the ACOMa complex and minimal exposure to the surrounding brain. The technique allowed early proximal control and 360-degree visualization of the aneurysm and its surroundings. RESULTS: The average aneurysm size was 6.4 mm. Total clip occlusion was achieved in 100%, confirmed by intraoperative indocyanine green videography and post-operative computer tomography angiography/cerebral angiography. At discharge, 93.5% were modified Rankin Scale (mRS) 0-2, and 99.0% were mRS 0-2 at 1 year follow up. There was zero mortality, and one patient with a giant aneurysm had a stable residual on follow-up. CONCLUSIONS: Microsurgical clipping of ACOM aneurysms using the pretemporal minimal durotomy approach results in more durable outcomes than endovascular technique with excellent functional outcomes and should be strongly considered as a first treatment option, especially in aneurysms that have anatomic endovascular disadvantages that have a high likelihood of recurrence.