The Treatment of Anterior Communicating Artery Aneurysms by Proximal Occlusion of the Dominant Anterior Cerebral Artery.

Lee, Ki Chan; Chu, Jeong Wha; Jun, Dong Whee; Ro, Soon Sung

Original Article

Journal of Korean Neurosurgical Society 1977;6(2): 411-418.

Ki Chan Lee, Jeong Wha Chu, Dong Whee Jun, Soon Sung Ro

Department of Neurosurgery, College of Medicine, Korea University, Korea.

ABSTRACT

A direct intracranial operative approach that occludes the neck of the aneurysmal sac by clipping, and excludes it from the circulation without interference with the lumen of the parent vessel, is the ideal treatment of symptomatic intracranial aneurysm. With this procedure, however, there is no assurance of complete obliteration of the aneurysmal sac. Furthermore aneurysms arising from the anterior communicating artery are particularly dangerous because of the effects produced by spasm of the important neighboring perforating vessels. Since Logue published on the treatment of anterior communicating aneurysms by proximal ligation of an anterior cerebral artery in 1956, there has been by the large number of series of cases reported by other surgeons. Tindall classified three pattern of angiographic filling in patients with anterior communicating aneurysms and in type III, each anterior cerebral artery fills from its respective side, while the aneurysm fills from one side only, proximal ligation of anterior cerebral artery was performed with good effect. Five patients with anterior communicating artery aneurysm were treated by proximal occlusion of the dominant anterior cerebral artery with no mortality or morbidity. There was also instance of recurrent hemorrhage during the follow up period for 8 months to 5 years. We thought this operative procedure, therefore, can offer a highly acceptable result if the surgeon applies strict criteria to patient selection. Technically, the procedure was simple, earlier and could be performed more quickly than the direct attack.