Clinical study of clipping ruptured anterior communicating aneurysms via contralateral pterional-craniotomy of dominant A1

doi:10.3877/cma.j.issn.2095-123X.2020.06.002

Abstract

Abstract:

Objective

To compare the effect of clipping ruptured anterior communicating aneurysms between contralateral pterional-craniotomy of dominant A1 and dominant A1 lateral pterional-craniotomy, and explore the surgical indication.

Methods

The clinical data of 58 patients with ruptured anterior communicating aneurysms who underwent pterional-craniotomy clipping in Neurosurgery Department of Jiangxi Provincial People’s Hospital from September 2013 to September 2019 were reviewed. Among them, 32 cases were treated with contralateral pterional-craniotomy of dominant A1 (the dominant A1 group) and 26 cases with dominant A1 lateral (the dominant A1 lateral group). The operation time under the microscope, clipping mode (simple clipping, compound clipping), the residual or recurrent of the aneurysm at 3 months and 1-year post-operation, and GOS score at 1-year post-operation were statistically analyzed.

Results

In the contralateral pterional-craniotomy of the dominant A1 group, a simple clipping was performed in 25 cases and compound clipping in 7 cases, while 12 cases and 14 cases respectively in the dominant A1 lateral group, and there was a significant difference between the two groups (χ²=5.148, P=0.022). The microscopical duration of surgery of the dominant A1 lateral group was (1.57±0.32) h, 2 cases (6.25%) and 3 cases (9.38%) had aneurysm residual or recurrence 3 months after operation, and the 1-year good prognosis rate was 90.63%; those of the dominant A1 group were (1.63±0.37) h, 2 cases (7.69%), 2 cases (7.69%) and the 1-year good prognosis rate was 92.31%; there was no significant difference between the two groups (P>0.05).

Conclusion

Clipping anterior communicating aneurysms with a contralateral pterional-craniotomy of dominant A1 can facilitate the process of aneurysm neck exposure and simplify the clipping method, and surgeons must comply with a strict requisition for surgical indication.

Key words: Anterior communicating aneurysms, Rupture, Clipping, Dominant A1, Pterional-craniotomy

Wei Chen, Chaoyang Zhou, Bin Xi, Aijun Liang, Bin Zhou, Chunlian Liao, Xueju Cai, Dengfeng Wan. Clinical study of clipping ruptured anterior communicating aneurysms via contralateral pterional-craniotomy of dominant A1[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(06): 323-326.

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Figures/Tables 2

References 16

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资料		非优势A1侧组（n=32）	优势A1侧组（n=26）	t/χ²值	P值
性别（男/女）		13/19	14/12	1.008	0.315
年龄（岁，Mean±SD）		55.09±1.37	54.50±1.05	0.280	0.780
Hunt-Hess分级				1.489	0.473
	Ⅰ级	9	8
	Ⅱ级	12	6
	Ⅲ级	11	12
Fisher分级				0.111	0.946
	Ⅰ级	5	4
	Ⅱ级	16	12
	Ⅲ级	11	10
术前GCS评分				0.191	0.662
	9~12分	23	20
	13~15分	9	6
动脉瘤直径				0.489	0.783
	≤4 mm	17	13
	5~6 mm	12	9
	7~14 mm	3	4
动脉瘤朝向
	前上	15	12
	前下	7	6
	后上	8	5
	后下	2	3
优势A1侧别				0.019	0.890
	左侧	19	16
	右侧	13	10

资料		非优势A1侧组（n=32）	优势A1侧组（n=26）	t/χ²值	P值
性别（男/女）		13/19	14/12	1.008	0.315
年龄（岁，Mean±SD）		55.09±1.37	54.50±1.05	0.280	0.780
Hunt-Hess分级				1.489	0.473
	Ⅰ级	9	8
	Ⅱ级	12	6
	Ⅲ级	11	12
Fisher分级				0.111	0.946
	Ⅰ级	5	4
	Ⅱ级	16	12
	Ⅲ级	11	10
术前GCS评分				0.191	0.662
	9~12分	23	20
	13~15分	9	6
动脉瘤直径				0.489	0.783
	≤4 mm	17	13
	5~6 mm	12	9
	7~14 mm	3	4
动脉瘤朝向
	前上	15	12
	前下	7	6
	后上	8	5
	后下	2	3
优势A1侧别				0.019	0.890
	左侧	19	16
	右侧	13	10

项目		非优势A1侧组（n=32）	优势A1侧组（n=26）	t/χ²/Z值	P值
手术时间（h，Mean±SD）		1.57±0.32	1.63±0.37	0.601	0.551
夹闭方式[例（%）]				5.148	0.023
	简单夹闭	25（78.13）	12（46.15）
	复杂夹闭	7（21.87）	14（53.85）
夹闭完全[例（%）]				0.019	0.890
	术后3个月	30（93.75）	24（92.31）
残留或复发[例（%）]
	术后3个月	2（6.25）	2（7.69）	0.019	0.890
	术后1年	3（9.38）	2（7.69）	0.070	0.792
GOS评分[例（%）]				0.186	0.911
	4~5分	29（90.63）	24（92.31）
	3分	2（6.25）	1（3.84）
	1~2分	1（3.12）	1（3.84）

项目		非优势A1侧组（n=32）	优势A1侧组（n=26）	t/χ²/Z值	P值
手术时间（h，Mean±SD）		1.57±0.32	1.63±0.37	0.601	0.551
夹闭方式[例（%）]				5.148	0.023
	简单夹闭	25（78.13）	12（46.15）
	复杂夹闭	7（21.87）	14（53.85）
夹闭完全[例（%）]				0.019	0.890
	术后3个月	30（93.75）	24（92.31）
残留或复发[例（%）]
	术后3个月	2（6.25）	2（7.69）	0.019	0.890
	术后1年	3（9.38）	2（7.69）	0.070	0.792
GOS评分[例（%）]				0.186	0.911
	4~5分	29（90.63）	24（92.31）
	3分	2（6.25）	1（3.84）
	1~2分	1（3.12）	1（3.84）

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