MICROSURGICAL MANAGEMENT IN ANTERIOR COMMUNICATING ARTERY ANEURYSMS: AN ANATOMICAL INVESTIGATION

Abstract

Purpose: The purpose of this study is to compare the pterional approach and the anterior interhemisphericapproach for enabling a better surgical maneuverability. We describe the ideal the anatomic limitations ofthis surgery for anterior communicating artery aneurysms.Methods: Four formalin-fixed and silicone injected human heads were used for each approach. Möller 20-1000 microscope (Wedel, Germany) was used for dissection and all the photographs were obtained at asimilar angle to the surgical microscope, with Canon EOS Rebel T5 Digital SLR Digital Camera with an EF100mm f/2.8L Macro IS USM Lens and a Canon MR-14EX II Macro Ring Lite Flash (Canon Inc., Ohta-ku,Tokyo, Japan). Our dissection includes anterior interhemispheric and pterional approach with gyrus rectusresection and posterolateral orbitotomy.Results: Pterional approach was performed followed by the gyrus rectus resection and posterolateralorbitotomy. This area can be exposed by the 1x1 cm resection of the gyrus rectus. Subpial resection fromposterior part of gyrus rectus is required. Posterolateral orbitotomy was performed and the orbital roof wasremoved. The anterior interhemispheric approach allows better visualization of the anterior and inferiorsurface of anterior communicating artery, A1-A2 junction and the optic nerve.Conclusions: We believe that the pterional approach combined with gyrus rectus resection andposterolateral orbitotomy is more suitable for anterior, posterior and inferior type anterior communicatingartery aneurysms. Also, anterior interhemispheric approach can be considered as safer route for superiorand high positioned type.