[Follow-up results of cases with anterior communicating aneurysm operated on in the acute stage -with special reference to time-course of morbidity after operations- (author's transl)]

The microsurgical anterior interhemispheric approach suitably applied to ruptured aneurysms of the anterior communicating artery in the acute stage

From 1973 to 1980, 177 cases with ruptured aneurysms of the anterior communicating artery (Aco) have been operated on using various microsurgical procedures. Since 1974, 136 cases were directly operated on using the microsurgical anterior interhemispheric (AIH) approach: a modification of Lougheed's approach. The overall mortality was 5%. The early operations, within 1 week of onset of subarachnoid haemorrhage had a 3% mortality in grade 1 and 2 patients; a 16% mortality in grade 3 and 4 and a 25% mortality in grade 5 patients. The rate of cases in which the patient was independent following surgery was 92% in grade 1 and 2 patients, 47% in grade 3 and 4, and 25% in grade 5 in the same group. The AIH approach for severe cases in the acute stage has the following benefits: 1. The retraction pressure on the brain in the AIH approach is half as much as that in Yaşargil's approach. The aneurysms can be operated on with less retraction of the brain and thus without damaging the brain, olfactory nerves, bridging veins, hypothalamic arteries and other perforating arteries. 2. Various types of aneurysms, whatever their position, especially those located high and in a posterior direction, can be easily clipped. 3. Adequate removal of clots can be achieved from the interhemispheric fissure, the chiasmatic and the prepontine cisterns and the frontal lobe. 4. Interarterial anastomosis between both anterior cerebral arteries can be applied if necessary to allow easy clipping on unusual aneurysms. 5. Temporary occlusion of A1's and A2's and external decompression can be easily done if necessary.