Microsurgical management in Anterior Communicating Artery Aneurysms: an anatomical investigation

Abstract

Purpose: The purpose of this study is to compare the pterional approach and the anterior interhemispheric approach for enabling a better surgical maneuverability. We describe the ideal the anatomic limitations of this surgery for anterior communicating artery aneurysms. Methods: 4 formalin-fixed and silicone injected human heads were used for each approach. Möller 20-1000 microscope was used for dissection and all the photographs were obtained at a similar angle to the surgical microscope, with Canon EOS Rebel T5 Digital SLR Digital Camera with a EF 100mm f/2.8L Macro IS USM Lens and a Canon MR-14EX II Macro Ring Lite Flash. Our dissection includes anterior interhemispheric and pterional approach with gyrus rectus resection and posterolateral orbitotomy. Results: Pterional approach was performed followed by the gyrus rectus resection and posterolateral orbitotomy. This area can be exposed by the 1x1 cm resection of the gyrus rectus. Subpial resection from posterior part of gyrus rectus is required. Posterolateral orbitotomy was performed and the orbital roof was removed up to the superior orbital fissure. The anterior interhemispheric approach allows better visualization of the anterior and inferior surface of anterior communicating artery, A1-A2 junction and the optic nerve. Conclusions: We believe the pterional approach combined with gyrus rectus resection and posterolateral orbitotomy, if needed, is more suitable for anterior, posterior and inferior type, with anterior interhemispheric approach being the safer for superior and high positioned anterior communicating artery aneurysms.