Treatment of Anterior Communicating Artery Aneurysm by Proximal Occlusion of the Anterior Cerebral Artery.

Ju, M B; Song, J U

Original Article

Journal of Korean Neurosurgical Society 1973;2(2): 7-14.

¹Department of Neurosurgery, Korea General Hospital, Korea.
²Department of Neurosurgery, St. Mary's Hospital Catholic Medical College, Korea.

ABSTRACT

It is reported that the rebleeding occurs comparatively frequently from aneurysms in the anterior communicating artery, and the rates of complication and mortality are also comparatively high in the operation of aneurysm of this area. Of the patients who were admitted into the Korea General Hospital and Catholic Medical College St. Mary's Hospital on account of spontaneous intracranial subarachnoid hemorrhage, and were discovered to have anterior communicating aneurysm by cerebral angiography, 12 cases were treated by proximal occlusion of the anterior cerebral artery with good results except 1 cases that died. These anterior communicating artery aneurysms which were treated by proximal occlusion of the anterior cerebral artery did not revealed the neck and direction of the aneurysm clearly and the angiographic pattern with regard to aneurysmin the anterior part of circle of Willis corresponds to type 3 or 5 of Okawara's classification, and comparatively good results were obtained by proximal occlusion of the anterior cerebral artery on the side which supplied dominant blood flow. Rebleeding or neurological deficit were seldom occurred by this treatment. The results were summarized as follows. 1) The 12 operated cases were between the ages of 32 and 60, comprising 8 males and 4 females. 2) Of the 12 cases, 5 had more than 2 bleedings, and the remaining had only 1 bleeding preoperatively. The interval between the last bleeding and operation was about a week, however, 6 cases had an interval of more than 2 weeks. The preoperative neurological state of these patients was in Botterell's classification grade 3 in 1 case, grade 2 in 1 case, and the remaining were grade 1. As for arterial spasm, 4 cases did not show spasm at all and 4 cases showed spasm adjacent to aneurysm and the others revealed spasm in a comparatively wide areas of carotid distribution. 3) The type of the anterior part of circle of Willis including anterior communicating artery aneurysm was type 1 in 1 case, type 3 in 3 cases and type 5 in 8 cases by Okawara's classification. As for Sedzimir's cross compression, 7 cases fell to type 1, 4 cases to type 2, and 1 case to type 3. 4) In operation, type 3 or type 5 of Okawara's classification were mainly adopted. One case belong to type 1 died after operation, but the other patients showed no neurologic deficit or rebleeding after operation. 5) In deciding the indication of proximal occlusion of anterior cerebral artery for anterior communication artery aneurysms, the authors examined closely the circulation pattern of the anterior part of circle of Willis including aneurysm in cases where the neck and direction of the anterior communicating artery aneurysms were not clear on the cerebral angiogram. In conducting surgical operations in type 3 or 5 of Okawara's classification, efforts were made to avoid damage to the perforating vessels and occluded the proximal portion of the anterior cerebral artery.