Interhemispheric approach for anterior communicating artery aneurysm and perforating artery injury

Abstract

Vascular injury to the perforating artery can occur during dissection around aneurysms. We encountered 11 cases of perforating artery injury during operations for 221 cases of anterior communicating artery (ACoA) aneurysms operated on using an interhemispheric approach between 1990 and 2001. We performed operations for 158 ruptured and 63 unruptured aneurysms. The mean patient age was 56.1 years. In performing aneurysm surgery, it is important that enough space is left at the aneurysm neck for the branching of vessels following clipping. All vessels in the anterior communicating artery complex, including the perforating artery, can be seen from an interhemispheric approach. However, surgery in elderly patients, or with sclerotic changes of the neck, Type 2B or large anterior communicating artery aneurysm, are at increased risk of perforating artery injury.