Role of preoperative computed tomography angiographic anatomical considerations and their intraoperative interpretations in prediction of outcome in microsurgical clipping of ruptured anterior communicating aneurysm

Ahmed Mohamed Ehsan Alawamry,Tarek Hassan Abdelbary,Ahmed Awad Bessar,Mostafa Farid,Mahmoud Mostafa Taha

doi:10.1186/s41984-021-00103-3

Ahmed Mohamed Ehsan Alawamry, Tarek Hassan Abdelbary + Show 3 more

Open Access

https://doi.org/10.1186/s41984-021-00103-3

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Abstract

BackgroundAnatomy of anterior communicating vascular complex is variable and sometimes causes troublesome situations during microsurgical clipping of ruptured anterior communicating (Acom) aneurysms. Preoperative understanding of anatomy, expecting the presence of normal variations, knowing the exact aneurysm morphometrics and understanding flow dynamic patterns, help to reach an appropriate surgical outcome.MethodsWe analyzed the preoperative angiographic anatomical findings in computed tomography angiography and compared them to the intraoperative microscopic anatomical finding in 52 patients who underwent microsurgical clipping of ruptured Acom aneurysms, to reach angiographic prognostic factors in ruptured Acom aneurysm surgery.ResultsThere is statistically significant relation between intraoperative anatomical factors and preoperative CTA findings (closed A2 aneurysm angle, neck extending to A2, anatomical variation, hypoplastic A1, and posterior projection).ConclusionCTA is a reliable method to predict the intraoperative anatomy in Acom aneurysm clipping. Poor outcome was more common among cases with posterior projection, closed A2-aneurysm angle, aneurysm neck extension to A2, and hypoplastic A1.

Highlights

Anterior communicating (Acom) complex is the most common location of cerebral aneurysms with incidence 30% [1]
We excluded 17 patients from this study, 10 patients who were treated with endovascular techniques, four patients presented with World Federation of Neurosurgeons (WFN) clinical grade more than grade three and 3 patients who were investigated initially by magnetic resonant angiography (MRA)
computed tomography angiography (CTA) prognostics in morbidity: Table 4 There is statistically non-significant relation between preoperative anatomical factors by CTA and postoperative morbidity

Summary

Introduction

Anterior communicating (Acom) complex is the most common location of cerebral aneurysms with incidence 30% [1]. This particular location involves five main arterial structures (ipsilateral A1, ipsilateral A2, contralateral A1, contralateral A2, and Acom artery), in addition to related arterial branches: recurrent artery of Heubner, With regard to the relationships between aneurysm site and size, ruptured Acom aneurysms tend to be smaller than aneurysms located at other sites, suggesting that the rupture rate of Acom aneurysms is highest among cerebral aneurysms. Anatomy of anterior communicating vascular complex is variable and sometimes causes troublesome situations during microsurgical clipping of ruptured anterior communicating (Acom) aneurysms. Preoperative understanding of anatomy, expecting the presence of normal variations, knowing the exact aneurysm morphometrics and understanding flow dynamic patterns, help to reach an appropriate surgical outcome

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Discussion

Conclusion