Anterior Communicating Artery Complex Aneurysms

Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases

Bradley N. Bohnstedt, Andrew R. Conger, John Edwards, Mary Ziemba-Davis, Gary Edwards, Jacqueline Brom, Kushal Shah, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

Abstract

Objective: Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome. Methods: The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed. Results: Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations. Conclusions: The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Intracranial Aneurysm
Aneurysm
Glasgow Outcome Scale
varespladib methyl
Surgical Instruments
Arteries
Ruptured Aneurysm
Ligation
Therapeutics
Demography
Databases
Hemorrhage

Keywords

  • Anatomy
  • Anterior communicating artery
  • Clip ligation
  • Intracranial aneurysm
  • Microsurgery
  • Treatment outcome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Anterior Communicating Artery Complex Aneurysms : Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases. / Bohnstedt, Bradley N.; Conger, Andrew R.; Edwards, John; Ziemba-Davis, Mary; Edwards, Gary; Brom, Jacqueline; Shah, Kushal; Cohen-Gadol, Aaron.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Bohnstedt, Bradley N. ; Conger, Andrew R. ; Edwards, John ; Ziemba-Davis, Mary ; Edwards, Gary ; Brom, Jacqueline ; Shah, Kushal ; Cohen-Gadol, Aaron. / Anterior Communicating Artery Complex Aneurysms : Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases. In: World Neurosurgery. 2018.
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title = "Anterior Communicating Artery Complex Aneurysms: Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases",
abstract = "Objective: Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome. Methods: The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed. Results: Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5{\%}) of aneurysms originated mainly from the ACoA artery; 12 (3.8{\%}) primarily from the A1 branch; 3 (0.9{\%}) from the A2 branch; and 162 (50.8{\%}) from the A1/A2 junction. Aneurysm projection was superior in 118 (37{\%}), inferior in 106 (33.2{\%}), anterior in 88 (27.6{\%}), and posterior in 7 (2.2{\%}). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations. Conclusions: The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.",
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T2 - Anatomic Characteristics as Predictors of Surgical Outcome in 300 Cases

AU - Bohnstedt, Bradley N.

AU - Conger, Andrew R.

AU - Edwards, John

AU - Ziemba-Davis, Mary

AU - Edwards, Gary

AU - Brom, Jacqueline

AU - Shah, Kushal

AU - Cohen-Gadol, Aaron

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N2 - Objective: Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome. Methods: The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed. Results: Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations. Conclusions: The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.

AB - Objective: Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome. Methods: The authors queried their institution's aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow Outcome Scale (GOS) scores at hospital discharge and 6-month as well as 1-year follow-up were analyzed. Results: Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations. Conclusions: The aneurysm's exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms.

KW - Anatomy

KW - Anterior communicating artery

KW - Clip ligation

KW - Intracranial aneurysm

KW - Microsurgery

KW - Treatment outcome

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DO - 10.1016/j.wneu.2018.10.172

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JF - World Neurosurgery

SN - 1878-8750

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