Degree of Difficulty in Neck Clipping of Anterior Communicating Artery Aneurysms

The degree of difficulty of surgery of an anterior communicating artery aneurysm (A com A aneurysm) depends on the position of the neck, size and projection of the aneurysm and relationship to major vessels.We have been using the pterional approach for operating on A com A aneurysms and have analyzed 47 cases of our experience with ruptured A com A aneurysms.The right pterional approach was used in forty-four cases (94%) and the left pterional approach was used in three cases (6%)Aneurysms were divided into four types: Type A: Aneurysm clipped anterior to bilateral A2; 19 cases (44%)Type B: Aneurysm clipped posteriorly between bilateral A2; 13 cases (30%)Type C: Aneurysm clipped anteriorly between bilateral A2; 5 cases (12%)Type D: Aneurysm clipped posterior to bilateral A2; 6 cases (14%)Type A was not difficult to clip, but types B, C and D were more difficult to clip than type A. Neck clipping was complicated in the following cases.·Aneurysm existed between bilateral A2·Aneurysm grew posteriorly to bilateral A2·Neck of aneurysm existed at the back of major vessels Lateral angiogram 20°. oblique anteriorly was close to the operative view of the aneurysms and was especially useful for predicting the degree of clipping difficulty.