Summary
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 of unusual aneurysms.
-
5.
Temporary occlusion of A1's and A2's and external decompression can be easily done if necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alvord, E. D., Loeser, J. D., Bailey, W. L., Compass, M. K., Subarachnoid haemorrhage due to ruptured aneurysms. Arch. Neurol.27 (1972), 273–281.
Heilbrum, M. P., Olesen, J., Lassen, N. A., Regional cerebral blood flow studies in subarachnoid haemorrhage. J. Neurosurg.37 (1972), 36–44.
Hori, S., Suzuki, J., Early and late results of intracranial direct surgery of anterior communicating artery aneurysms. J. Neurosurg.50 (1979), 433–440.
Ito, Z., Matsuoka, S., Moriyama, T., Hen, T., Sakurai, Y., Operative timing in ruptured cerebral aneurysms in the acute stage. In: Cerebral apoplexy, Vol. 1. Subarachnoid haemorrhage (Ohneda, G.,et al., eds.), pp. 83–93. Tokyo: Neuron Publishing. 1975.
Ito, Z., Application of microsurgical anterior interhemispheric approach for cerebral aneurysms. Special lecture. In: The first annual meeting of the Japanese congress of neurological surgeons, Tokyo, Feb. 21, 1981.
Ito, Z., A new technique of intracranial interarterial anastomosis between distal anterior cerebral arteries (ACA) for ACA occlusion and its indication. Neurol. Med. Chir.21 (1981), 931–939.
Kikuchi, H., Emergency operation of ruptured aneurysm. In: International Symposium on Cerebrovasoular Diseases: New trends in surgical and medical aspects, Gardone Riviera, Italy, July 2–4, 1981.
Ljunggren, B., Brandt, L., Kågström, E., Sundbärg, G., Results of early operations for ruptured aneurysm. J. Neurosurg.54 (1981), 473–479.
Lougheed, W. M., Selection, timing and technique of aneurysm surgery of the anterior circle of Willis. Clin. Neurosurg.16 (1969), 95–113.
Lougheed, W. M., Marshall, B. M., Management of aneurysms of the anterior circulation by intracranial procedures. In: Neurological Surgery (Youmans, J. R., ed.), pp. 731–767. Philadelphia-London-Toronto: W. B. Saunders. 1973.
Nornes, H., The role of intracranial pressure in the arrest of haemorrhage in patients with ruptured intracranial aneurysms. J. Neurosurg.39 (1973), 226–234.
Ohta, H., Ito, Z., Yasui, N., Suzuki, A., Extensive evacuation of subarachnoid clot for prevention of vasospasm-effective or not? In: Symposium, Aneurysm surgery in the acute stage. Graz, Austria, July 19–21, 1981. Acta neurochir. (Wien)63 (1982), 111–116.
Saito, I., Tamura, A., Sano, K., 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 —. Neurol. Med. Chir. (Tokyo)17, part II (1977), 233–241.
Saito, I., Ueda, Y., Sano, K., Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J. Neurosurg.47 (1977), 412–429.
Sakurai, Y., Ito, Z., Uemura, K., Pathophysiological aspects of acute stage patients with ruptured intracranial aneurysms. Part II: Relationships between neurological prognosis and sequential changes of cerebral blood flow dynamics. Brain Nerve27 (1975), 1213–1221.
Suzuki, J., Onuma, T., Yoshimoto, T., Results of early operations on cerebral aneurysms. Surg. Neurol.11 (1979), 407–412.
Symon, L., Disordered cerebro-vascular physiology in aneurysmal subarachnoid haemorrhage. Acta neurochir.41 (Wien) (1978), 7–22.
Yasui, N., Ito, Z., Ohta, H., Suzuki, A., Surgical problems and the pathophysiology in severe cases with ruptured aneurysms in the acute stage. In: Symposium, Aneurysm surgery in the acute stage. Graz, Austria, July 19–21, 1981. Acta neurochir. (Wien)63 (1982), 163–174.
Yaşargil, M. G., Microsurgery applied to neurosurgery, pp. 126–130. Stuttgart: G. Thieme. New York-London: Academic Press. 1969.
Yaşargil, M. G., Fox, J. L., Ray, M. W., The operative approach to aneurysms of the anterior communicating artery. In: Advances and Technical Standards in Neurosurgery, Vol. 2 (Krayenbühl, H.,et al., eds.), pp. 113–170. New York-Wien: Springer. 1975.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ito, Z. The microsurgical anterior interhemispheric approach suitably applied to ruptured aneurysms of the anterior communicating artery in the acute stage. Acta neurochir 63, 85–99 (1982). https://doi.org/10.1007/BF01728859
Issue Date:
DOI: https://doi.org/10.1007/BF01728859