关键词: 前交通动脉瘤; 动脉瘤夹闭手术; 大脑前动脉; 构型; 预后

Abstract: Objective To compare the surgical effect, operation procedure and intraoperative exposure of craniotomy clipping for anterior communicating aneurysms with of different spatial configurations superior blood supply on the left side, and to explore the related surgical indications. Methods The data of patients with left superior anterior communicating aneurysms receiving neurosurgical clipping in the Second Hospital of Shanxi Medical University from January 2013 to December 2021 were retrospectively analyzed. According to the positional relationship between the running direction of A2 segment of anterior cerebral artery (ACA) and the coronary plane, aneurysms were divided into four types: horizontal type, the angle between ACA and the coronary plane was less than 22.5°; longitudinal type, the angle between ACA and the sagittal plane was less than 22.5°; right anterior left posterior type, the right ACA in front and the angle between ACA and the coronary plane was between 112.5°-157.5°; right posterior left anterior type, the left anterior cerebral artery in front and the angle between ACA and the coronary plane was between 22.5°-67.5°. The operation time, clipping pattern (simple clipping or complex clipping), clipping results(complete clipping or not) , aneurysm recurrence from 3 months to 1 year and GCS score at 1 year after operation were compared between horizontal type and longitudinal type, between right anterior left posterior type and right posterior left anterior type. Results A total of 50 patients were included in the study, including 8 cases of horizontal type, 12 cases of longitudinal type, 16 cases of right anterior left posterior type, and 14 cases of right posterior left anterior type. There were no statistical differences in all the clinical indexes between horizontal type and longitudinal type. There were no statistical differences in the baseline data between right anterior left posterior type and right posterior left anterior type, while the operation time in right anterior left posterior type was shorter than that in right posterior left anterior type (85.1±19.2 min vs.102.1±57.5 min, P=0.032), and there were no statistical differences in the aneurysm recurrence rate and prognosis between the two groups. Conclusions For patients with left superior anterior communicating aneurysms, the operation time in right anterior left posterior type (based ACA) was shorter than that in right posterior left anterior type, and there was no statistical difference in prognosis indexes between the two groups; there were no statistical differences in operation and prognosis indexes between horizontal type and longitudinal type.

Key words: Anterior communicating aneurysm; Aneurysm clipping; Anterior cerebral artery; Configuration; Prognosis