Approach side selection for microsurgical clipping of ruptured anterior communicating artery aneurysms

Abstract Background Anterior communicating artery aneurysms represent 30–45% of all intracranial aneurysms, with high incidence of rupture leading to significant morbidity and mortality. As the anterior communicating artery is a midline structure, it can be approached through anterior interhemispheric approach or pterional approach from right or left side. The study aimed to help decision making regarding right or left side pterional approach for ruptured anterior communicating artery aneurysms, based on anatomical and pathological variants. Results Twenty patients (13 males and 7 females) with a mean age of 61 years (range from 23 to 81 years) harboring ruptured anterior communicating artery aneurysms had been surgically clipped. All cases were operated through the pterional approach, 10 cases had left A1 dominance, all of them were operated from the left side, 10 cases were operated from rt side, 2 of them had right A1 dominance and 8 cases had A1 codominence, A2 fork was open in 10 cases. The most frequent postoperative complication met was cognitive impairment. One case died due to vasospasm, in this case A1 was dominant on rt side, A2 fork was closed. Conclusion Approach side selection for microsurgical clipping of anterior communicating artery aneurysm depends mainly on A1 dominance which enables early proximal control and avoids premature aneurysm rupture. Open A2 fork facilitates surgery but has no significant effect on surgical outcome.