Title: Complication Avoidance in Acom Aneurysm Surgery- An Early Experience of 16 Cases

Authors: Md Moshiur Rahman, Prof Dr Umme Kulsum Sharmin Zaman

 DOI: https://dx.doi.org/10.18535/jmscr/v6i11.125

Abstract

Introduction: A lot of controversies are there in treating Acom aneurysm surgery. Proximal control, timing of surgery, Sylvian fissure dissection, approach and patient selection are few of those. Avoiding major disasters such as perforator injury is mandatory, proximal control of both A1 in intraoperative rupture is worth living. The technique of arachnoid dissection to prevent injury to AcoA complex and brain retraction facilitates surgery.  In this series, complication avoidance of 16 cases has been discussed. In order to avoid a major disaster such as perforator injury, proximal control of both A1 in intraoperative rupture is deserving of life. The arachnoid dissection technique to prevent injury to the AcoA complex and brain retraction facilitates the surgery. In this series, Complication avoidance of 16 cases was discussed.

Material and Method: A retrospective study of 16 cases of which 9 were male and 7 were female was observed. Prevention of complications has been studied in Acom aneurysm surgery.

Results: Of 16 patients — 2 died 1 developed 3rd nerve paralysis which was recovered after 3 months, 1 developed hydrocephalus.

Conclusion: The complexity of the location means that complications in Acom neurysm surgery must be avoided. The learning curve to avoid complications is a step in the right direction. Collection of larger series will contribute further to society.

Keywords: Acom aneurysm surgery, Proximal control, AcoA complex.

References

  1. Riina H A, Lemole M G, Spetzler R F. Anterior communicating aneurysms. Neurosurgery. 2002;51:993–996. [PubMed]
  2. Solomon R A. Anterior communicating artery aneurysms. Neurosurgery. 2001;48:119–123. [PubMed]
  3. Buchanan K M, Elias L J, Goplen G B. Differing perspectives on outcome after subarachnoid hemorrhage: the patient, the relative, the neurosurgeon. Neurosurgery. 2000;46:831–840. [PubMed]
  4. DeLuca J. Cognitive dysfunction after aneurysm of the anterior communicating artery. J Clin Exp Neuropsychol. 1992;14:924–934. [PubMed]
  5. Mavaddat N, Sahakian B J, Hutchinson P JA, Kirkpatrick P J. Cognition following subarachnoid hemorrhage from anterior communicating aneurysm: relation to timing of surgery. J Neurosurg. 1999;91:402–407. [PubMed]
  6. Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360:1267–1274. [PubMed]
  7. Molyneux A J, Kerr R S, Yu L M, et al. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809–817. [PubMed]
  8. Giannotta S L, Oppenheimer J H, Levy M L, Zelman V. Management of intraope-rative rupture of aneurysm without hypotension. Neurosurgery. 1991;28:531–535. [PubMed]
  9. Iwamoto H, Kiyohara Y, Fujishima M, et al. Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period: the Hisayama study. Stroke. 1999;30:1390–1395. [PubMed]
  10. Kamitani H, Masuzawa H, Kanazawa I, Kubo T. Saccular cerebral aneurysms in young adults. Surg Neurol. 2000;54:59–66. [PubMed]
  11. Le Roux P D, Elliott J P, Downey L, et al. Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients. J Neurosurg. 1995;83:394–402. [PubMed]
  12. Le Roux P D, Elliott J P, Newell D W, Grady M S, Winn H R. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg. 1996;85:39–49. [PubMed]
  13. Le Roux P D, Elliott J P, Newell D W, Grady M S, Winn H R. The incidence of surgical complications is similar in good and poor grade patients undergoing repair of ruptured anterior circulation aneurysms: a retrospective review of 355 patients. Clinical study. Neurosurgery. 1996;38: 887–895. [PubMed]
  14. Ljunggren B, Säveland H, Brandt L. Causes of unfavorable outcome after early aneurysm operation. Neurosurgery. 1983;13:629–633. [PubMed]
  15. Røsenorn J, Eskesen V, Schmidt K, et al. Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg. 1987;1:33–45. [PubMed]
  16. Sundt T M, Jr, Whisnant J P. Subarachnoid hemorrhage from intracranial aneurysms: surgical management and natural history of disease. N Engl J Med. 1978;299:116–122. [PubMed]
  17. Alaywan M, Sindou M. Fronto-temporal approach with orbito-zygomatic removal: surgical anatomy. Acta Neurochir (Wien) 1990;104:79–83. [PubMed]
  18. Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987;21:474–477. [PubMed]
  19. Czirják S, Szeifert G. Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision. Neurosurgery. 2001;48:145–150. [PubMed]
  20. Dare A O, Landi M K, Lopes D K, Grand W. Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. J Neurosurg. 2001;95:714–718. [PubMed]
  21. Figueiredo E G, Deshmukh P, Zabramski J M, et al. Quantitative anatomic study of three surgical approaches to the anterior communicating artery complex. Neurosurgery. 2005;56:397–405. [PubMed]
  22. Fujitsu K, Kuwabara T. Orbitocraniobasal approach for anterior communicating artery aneurysms. Neurosurgery. 1986;18:367–369. [PubMed]
  23. Jho H-D. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg. 1997;40:91–97. [PubMed]
  24. http://www.ncbi.nlm.nih.gov/pubmed/8750656
  25. Andaluz N, Loveren H R van, Keller J T, Zuccarello M. Anatomic and clinical study of the orbitopterional approach to anterior communicating artery aneurysms. Neurosurgery. 2003;52:1140–1148. [PubMed]

Corresponding Author

Dr Md Moshiur Rahman

Assistant Professor (current charge), Neurosurgery Department, HFRCMC, Dhaka, Bangladesh