Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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The Clinical Analysis of Anterior Communicating Artery Aneurysm Based on the Direction of Aneurysm

전교통동맥류의 방향에 따른 임상분석

  • Cho, Won Ho (Department of Neurosurgery, Pusan National University School of Medicine) ;
  • Choi, Chang Hwa (Department of Neurosurgery, Pusan National University School of Medicine) ;
  • Lee, Jae Il (Department of Neurosurgery, Pusan National University School of Medicine) ;
  • Ko, Jun Kyeung (Department of Neurosurgery, Pusan National University School of Medicine)
  • 조원호 (부산대학교 의학전문대학원 신경외과학교실) ;
  • 최창화 (부산대학교 의학전문대학원 신경외과학교실) ;
  • 이재일 (부산대학교 의학전문대학원 신경외과학교실) ;
  • 고준경 (부산대학교 의학전문대학원 신경외과학교실)
  • Published : 2011.09.30
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Abstract

Objective : It has been known that the prognosis of aneurysm rupture is depend on the preoperative clinical state, presence of rebleeding, vasospasm, hydrocephalus, but the direction of aneurysm might be one of the important prognostic factors in the anterior communicating artery (ACOM) aneurysm. Methods : One hundred forty three cases of ACOM aneurysms, operated from 1996 to 2005, were analysed retrospectively according to the surgical outcomes and directions of aneurysms. Result : The results of analysis were summarized as follows 1) The direction of ACOM aneurysms were as follows; anterior-superior direction in 33.6%, anterior-inferior 30.1%, posterior-superior 10.5%, anterior 7.7%, superior 7.0%, inferior 7.0% and posterior-inferior in 4.2%. 2) There was no significant relationship between the direction of aneurysm and the preopertive clinical state, but the incidence of Hunt-Hess grade IV and V was high in the posterior-superior and anterior-superior direction groups. 3) Intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) was accompanied in 28.7%. In posterior-superior and anterior-superior direction group, there is statistically significance between direction and IVH or ICH (p < 0.05). 4) Vasospasm was observed in 23.8% and cerebral infarction in 17.5%. The incidence was increased in the posterior-superior group. 5) Superior and posterior-superior direction group showed high mortality rate (20.0%). Conclusion : Although there was no statistic significance, we found that the direction of aneurysm might affect the clinical characteristics and prognosis in the patients underwent clipping surgery of ACOM aneurysm. Especially, posterior-superior and anterior-superior direction groups revealed the high incidence of ICH, IVH, vasospasm and cerebral infarction. Therefore, we should pay more careful attention to the patients with the superiorly directed ACOM aneurysms.

Keywords

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