Side selection of pterional approach for anterior communicating artery aneurysms – surgical anatomy and strategy

摘要

Background. To evaluate our decision policy based on vertical aneurysm projection for selecting the side of the pterional approach for the surgical treatment of anterior communicating artery aneurysms. Methods. Inferiorly projecting aneurysms were treated through the dominant A1 side, and superiorly projecting aneurysms were treated through the side of aneurysm fundus projection. We analysed postoperative outcome and surgical complications, and the correlations between the anatomical factors such as position (high or low), projection (dorsal or anterior), and the plane containing both A2 vessels (open A2 plane defined as the A2 of the approach side located more posteriorly than the contralateral A2; closed A2 plane as the ipsilateral A2 located more anteriorly than the contralateral A2), to assess the surgical requirements of approaches in patients with superiorly projecting aneurysms.