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

摘要： 目的 比较左侧优势血供的不同空间构型前交通动脉瘤开颅夹闭手术过程、效果及术中暴露情况，并探讨与之相关的手术适应证。 方法 回顾性分析山西医科大学第二医院2013年1月-2021年12月连续收治的确诊为左侧优势血供前交通动脉瘤，且进行了动脉瘤开颅夹闭手术的患者资料。根据大脑前动脉A2段的走行方向与冠状面的位置关系，将动脉瘤分为4型：大脑前动脉与冠状面夹角＜22.5°为水平型；大脑前动脉与矢状面夹角＜22.5°为纵向型；右侧大脑前动脉在前且与冠状面夹角112.5°～157.5°为右前左后型；左侧大脑前动脉在前且与冠状面夹角22.5°～67.5°为右后左前型。分别比较水平型组和纵向型组，右前左后型组和右后左前型组间的基线资料、进行左侧翼点入路夹闭手术的时间、夹闭方式（简单夹闭或复杂夹闭）、夹闭效果（是否完全夹闭）、术后3个月和1年动脉瘤是否复发、术后1年GCS评分等指标。 结果 研究共纳入50例患者，其中水平型8例，纵向型12例，右前左后型16例，右后左前型14例。水平型组与纵向型组各项指标差异均无统计学意义。右前左后型组与右后左前型组术前基线资料差异无统计学意义，右前左后型组的手术时间短于右后左前型组（85.1±19.2 min vs. 102.1±57.5 min，P=0.032），2组术后动脉瘤复发率、预后差异无统计学意义。 结论 右前左后型前交通动脉瘤的手术时间短于右后左前型，但预后方面与右后左前型无显著差异；水平型与纵向型前交通动脉瘤的手术和预后指标无显著差异。

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