Abstract
Surgery for intracranial aneurysms can be divided into two types : (1) surgery for acute-stage ruptured aneurysms ; and (2) delayed surgery for ruptured aneurysms and surgery for non-ruptured aneurysms. The purpose of this paper is to discuss operative techniques for acute-stage anterior communicating artery aneurysms. In approaching the aneurysms, cerebral retraction must be minimized, and on initiating the intradural procedure by aspirating the CSF from the chiasmatic cistern via the narrow gap between the frontal lobe and the skull base, the distended brain is slackened. This thus minimizes frontal lobe retraction. Anterior communicating artery aneurysms present in the narrow space surrounded by five arteries and the brain may be found to adhere to the chiasma or be hidden in the interhemispheric fissure, and the authors discribe operative techniques developed for the anatomical features of such anterior communicating artery aneurysms. In addition to preventing an aneurysmal rerupture by neck clipping, surgery for acute-stage intracranial aneurysms should be directed toward preventing vasospasms and hydrocephalus. For this purpose, extensive washing to eliminate the hematoma filling the subarachnoid space is necessary. The authors stress the usefulness of securing an unobstructed, absorbant pathway for the CSF by opening Liliequist's membrane and the lamina terminalis.
