Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture

Authors

DOI:

https://doi.org/10.14739/2409-2932.2023.2.278867

Keywords:

anterior communicating artery, aneurysm, clipping, aneurysm rupture, recurrence

Abstract

The aim of this study is to evaluate the efficacy of microsurgical clipping of anterior communicating artery (AComA) aneurysms as a method of prevention of repeated aneurysm rupture.

Materials and methods. A total of 98 patients were included in the study, with a mean age of 47.8 ± 11.0 years. The female-to-male ratio was 1.04 : 1.00. Aneurysms were verified using computer tomography of the head and neck vessels, selective cerebral angiography, and MRI angiography of cerebral vessels.

Results. Pterional access was used for surgical intervention in all patients. In the first three days after the aneurysm rupture, microsurgical treatment was performed on 18 of the most severe patients. After three days and later, surgical intervention was performed in patients with compensated and sub-compensated conditions. Patients were further examined; microsurgical tactics were carefully planned. Brain compression, pronounced dislocation, and occlusive hydrocephalus were indications for emergency surgery. Angiospasm was detected in 45 patients (45.9 %), among them pronounced angiospasm was detected in 36 %, widespread – in 20 %, intracerebral hematomas – in 30 (30.6 %), intraventricular hemorrhages – in 28 (28.6 %). In five cases, intracerebral hematomas led to pronounced compression of the brain and dislocation of the middle structures. These patients underwent hematoma removal and aneurysm clipping. Half of the patients had simultaneous intraventricular hemorrhages and intracerebral hematomas of the frontal lobes and the blood was most often localized in several ventricles. Four patients with decompensated hydrocephalus underwent ventricular drainage and CSF bypass operations before aneurysm clipping. Postoperative mortality in this group of patients was 11 %, and severe neurological deficits were 22 %.

It was established that repeated ruptures of AComA aneurysms occurred in 15 % of treated patients after admission to the hospital.

Conclusions. Microsurgical treatment provides a minimally invasive approach that minimizes damage to the surrounding brain tissue and helps preserve brain function and minimizes the risk of postoperative neurological complications.

Author Biography

І. О. Shkil, Municipal Non-Commercial enterprise “Zaporizhzhia Regional Clinical Hospital” of Zaporizhzhia City Council, Ukraine

MD, Neurosurgeon of Higher Attestation Category

References

Peng, C., Diao, Y. H., Cai, S. F., & Yang, X. Y. (2022). Endovascular coiling versus microsurgical clipping for ruptured intracranial aneurysms: a meta-analysis and systematic review. Chinese neurosurgical journal, 8(1), 17. https://doi.org/10.1186/s41016-022-00283-3

Forbes, J. A., D'herbemont, S., Lehner, K. R., Pineda Martinez, D., Navarro-Chávez, I. P., Mendez Rosito, D., & Schwartz, T. H. (2018). Feasibility of endoscopic endonasal approach for clip application of cerebral aneurysms: a systematic review. Journal of neurosurgical sciences, 62(6), 650-657. https://doi.org/10.23736/S0390-5616.18.04405-3

Harris, L., Hill, C. S., Elliot, M., Fitzpatrick, T., Ghosh, A., & Vindlacheruvu, R. (2021). Comparison between outcomes of endovascular and surgical treatments of ruptured anterior communicating artery aneurysms. British journal of neurosurgery, 35(3), 313-318. https://doi.org/10.1080/02688697.2020.1812517

Belavadi, R., Gudigopuram, S. V. R., Raguthu, C. C., Gajjela, H., Kela, I., Kakarala, C. L., Hassan, M., & Sange, I. (2021). Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms. Cureus, 13(12), e20478. https://doi.org/10.7759/cureus.20478

Lindgren, A., Vergouwen, M. D., van der Schaaf, I., Algra, A., Wermer, M., Clarke, M. J., & Rinkel, G. J. (2018). Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. The Cochrane database of systematic reviews, 8(8), CD003085. https://doi.org/10.1002/14651858.CD003085.pub3

Lee, S. H., & Park, J. S. (2022). Outcome of ruptured anterior communicating artery aneurysm treatment compared between surgical clipping and endovascular coiling: A single-center analysis. Medicine, 101(38), e30754. https://doi.org/10.1097/MD.0000000000030754

Sattari, S. A., Shahbandi, A., Lee, R. P., Feghali, J., Rincon-Torroella, J., Yang, W., Abdulrahim, M., Ahmadi, S., So, R. J., Hung, A., Caplan, J. M., Gonzalez, F., Tamargo, R. J., Huang, J., & Xu, R. (2023). Surgery or Endovascular Treatment in Patients with Anterior Communicating Artery Aneurysm: A Systematic Review and Meta-Analysis. World neurosurgery, 175, 31-44. Advance online publication. https://doi.org/10.1016/j.wneu.2023.03.111

Nowicki, J., Harding, M., & Aromataris, E. (2022). Clinical outcomes of microvascular clipping compared to endovascular coiling for ruptured anterior communicating artery aneurysms: a systematic review protocol. JBI evidence synthesis, 20(8), 2032-2039. https://doi.org/10.11124/JBIES-21-00332

Brzegowy, P., Kucybała, I., Krupa, K., Łasocha, B., Wilk, A., Latacz, P., Urbanik, A., & Popiela, T. J. (2019). Angiographic and clinical results of anterior communicating artery aneurysm endovascular treatment. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques, 14(3), 451-460. https://doi.org/10.5114/wiitm.2019.81406

Lawton, M. T., & Vates, G. E. (2017). Subarachnoid Hemorrhage. The New England journal of medicine, 377(3), 257-266. https://doi.org/10.1056/NEJMcp1605827

Chung, D. Y., Abdalkader, M., & Nguyen, T. N. (2021). Aneurysmal Subarachnoid Hemorrhage. Neurologic clinics, 39(2), 419-442. https://doi.org/10.1016/j.ncl.2021.02.006

Zhu, W., Ling, X., Petersen, J. D., Liu, J., Xiao, A., & Huang, J. (2022). Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies. Neurosurgical review, 45(2), 1291-1302. https://doi.org/10.1007/s10143-021-01704-0

Williams, L. N., & Brown, R. D., Jr (2013). Management of unruptured intracranial aneurysms. Neurology. Clinical practice, 3(2), 99-108. https://doi.org/10.1212/CPJ.0b013e31828d9f6b

Beuing, O., Lenz, A., Donitza, A., Becker, M., Serowy, S., & Skalej, M. (2020). Stent-assisted coiling of broad-necked intracranial aneurysms with a new braided microstent (Accero): procedural results and long-term follow-up. Scientific reports, 10(1), 412. https://doi.org/10.1038/s41598-019-57102-6

Nussbaum, E. S., Touchette, J. C., Madison, M. T., Goddard, J. K., Lassig, J. P., & Nussbaum, L. A. (2020). Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature. Operative neurosurgery, 19(6), 678-690. https://doi.org/10.1093/ons/opaa214

Kim, M., Kim, B. J., Son, W., & Park, J. (2021). Postoperative Clipping Status after a Pterional versus Interhemispheric Approach for High-Positioned Anterior Communicating Artery Aneurysms. Journal of Korean Neurosurgical Society, 64(4), 524-533. https://doi.org/10.3340/jkns.2020.0215

Fukuda, H., Hamada, F., Nonaka, M., Ueba, Y., Fukui, N., Kurosaki, Y., Morioka, J., Koyanagi, M., Nakajima, N., Uezato, M., Yasuda, T., Chin, M., Yamagata, S., Murao, K., Yamada, K., Ohta, T., Lo, B., & Ueba, T. (2021). Impact of subcallosal artery origin and A1 asymmetry on surgical outcomes of anterior communicating artery aneurysms. Acta neurochirurgica, 163(11), 2955-2965. https://doi.org/10.1007/s00701-021-04979-w

Published

2023-07-03

How to Cite

1.
Shkil ІО. Microsurgical clipping of anterior communicating artery aneurysms as a method of prevention of repeated aneurysm rupture. Current issues in pharmacy and medicine: science and practice [Internet]. 2023Jul.3 [cited 2024Apr.14];16(2):175-80. Available from: http://pharmed.zsmu.edu.ua/article/view/278867

Issue

Section

Original research