Dominant A1 Direction As An Additional Factor For Deciding Surgical Approach for A1 bifurcation Aneurysms.
A1 artery geometry
Anterior communicating artery aneurysms
Dominant A1
Flow dynamics
aneurysm Neck
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
20 Nov 2023
20 Nov 2023
Historique:
received:
30
10
2023
accepted:
14
11
2023
medline:
23
11
2023
pubmed:
23
11
2023
entrez:
22
11
2023
Statut:
aheadofprint
Résumé
Clipping of the Anterior communicating artery (AcomA) located aneurysms is considered a critical surgical procedure for neurosurgeons worldwide due to the complexity of the surgical area. The present study is conducted to discuss the importance of the geometrical curvatures and the direction of the dominant A1 artery and their impact on aneurysmal growth direction and choice of side selection of the Pterional surgical approach side. The present study enrolled 183 patients with ruptured AcomA-located aneurysms. the aneurysms were all treated surgically through a Pterional approach. Because of multiple dominant A1 direction, we divided the artery into 2 segments and based on the second segment direction we categorized the patients into Ascending A1, Descending A1, and Horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, while the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms respectively. Contralateral Pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral Pterional approach was conducted in horizontal and descending A1 dominant groups. The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory perforators inspection was achieved through the contralateral approach in most cases of an ascending A1 especially if ipsilateral A2 is posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the Aneurysmal neck is exposed in ascending A1 geometries. A1 direction is an important additional factor that is to be considered for side selection when deciding Pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from ipsilateral approach especially if the ipsilateral A2 was posterior to the neck.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Clipping of the Anterior communicating artery (AcomA) located aneurysms is considered a critical surgical procedure for neurosurgeons worldwide due to the complexity of the surgical area. The present study is conducted to discuss the importance of the geometrical curvatures and the direction of the dominant A1 artery and their impact on aneurysmal growth direction and choice of side selection of the Pterional surgical approach side.
METHODS
METHODS
The present study enrolled 183 patients with ruptured AcomA-located aneurysms. the aneurysms were all treated surgically through a Pterional approach. Because of multiple dominant A1 direction, we divided the artery into 2 segments and based on the second segment direction we categorized the patients into Ascending A1, Descending A1, and Horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, while the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms respectively. Contralateral Pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral Pterional approach was conducted in horizontal and descending A1 dominant groups.
RESULTS
RESULTS
The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory perforators inspection was achieved through the contralateral approach in most cases of an ascending A1 especially if ipsilateral A2 is posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the Aneurysmal neck is exposed in ascending A1 geometries.
CONCLUSION
CONCLUSIONS
A1 direction is an important additional factor that is to be considered for side selection when deciding Pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from ipsilateral approach especially if the ipsilateral A2 was posterior to the neck.
Identifiants
pubmed: 37992991
pii: S1878-8750(23)01621-2
doi: 10.1016/j.wneu.2023.11.058
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Elsevier Inc. All rights reserved.