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Journal of Korean Neurosurgical Society > Volume 15(1); 1986 > Article
Journal of Korean Neurosurgical Society 1986;15(1): 75-84.
Results of Direct Intracranial Surgery and Classification for 135 Anterior Communicating Artery Aneurysms.
Min Woo Baik, Dal Soo Kim, Young Kim, Chun Kun Park, Moon Chan Kim, Sang Won Lee, Tae Hoon Cho, Byoung Il Cho, Jae Soo Lee, Suck Hoon Yoon, Young Soo Ha, Joon Ki Kang, Jin Un Song
Department of Neurosurgery, Catholic Medical College, Seoul, Korea.
ABSTRACT
During the 10-year period up to December 1984, 176 patients with anterior communicating aneurysn(ACOMA) among total 467 patients of intracranial aneurysms were admitted to this Catholic Medical Center. Of these, 135 cases of ACOMA were operated by direct intracranial procedures. To analyse the factors influencing the mortality involving in surgery of 135 patients with ACOMA, a classification of ACOMA was attempted. The origins and projections of aneurysms, anatomical variations were analysed with the aid of angiography, intraoperative findings and intraoperative photographs which permitted the establishment of a classification of ACOMA with their direction. Our classification of operated 135 cases of ACOMA are seven types : 32 anterior(23.7%), 30 anterior-rostral(22.2%), 42 antefior-caudal(31.1%), 3 posterior(2.2%), 18 posterior-rostral(13.4%), 4 posteriorcaudal(3.0%), caudal 6(4.4%), respectively. Most of ACOMA projecting anteriorly, anterio-rostrally were situated above or between the optic nerve, and the less frequent posterior-caudal and inferior aneurysms were in close proximity to hypothalamic branches of the anterior communicating artery and A2 segment. There was on overall operative mortality of 6%. The surgical morbidity and mortality were significantly higher in the posteriorly projecting group, garticulary in the posterior-caudal direction. In direct surgery of ACOMA, subpial resection of the gyrus rectus was effective for not only anteriorly, but also posteriorly directing aneurysms.
Key Words: Anterior communicating artery aneurysm; Direction of aneurysm; Surgical mortality; Gyrus rectus resection
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