抄録
The anterior communicating artery (ACoA) is the most frequent site of aneurysms. This aneurysm is usually operated on via an interhemispheric or a pterional approach. The author routinely selects the pterional approach for the ACoA aneurysm because it allows the least brain retraction and excellent anatomical orientation. The interhemispheric approach was employed if the aneurysm was large, if the aneurysm was highly located, or if the distal anterior cerebral artery aneurysm was present. Of the author's 105 cases of ACoA aneurysms, 100 were clipped via a pterional approach, and the remaining 5 cases were clipped using an interhemispheric approach. I describe several important points, including preservation of the perforating arteries for the surgery of ACoA aneurysm via the pterional approach. The direction of the fundus is an important consideration in deciding the side of approach. Knowledge of the perforating arteries of the ACoA and the distal A1 segment is also mandatory. If the aneurysms project inferiorly, the right side is employed. If the aneurysms direct anteriorly or superiorly, the posteriorly locating A2 segment side is selected. If the aneurysms direct posteriorly, the anteriorly locating A2 segment side is selected. If the aneurysms project laterally, the aneurysms are approached from the dome side, not from the neck side. The most important points for the surgery of ACoA aneurysms via the pterional approach are the access to the aneurysm through a minimal retraction of the frontal lobe and the neck clipping of the aneurysm through a minimally invasive manipulation of the basal forebrain surrounding the aneurysms.
