Role of preoperative computed tomography angiographic anatomical considerations and their intraoperative interpretations in prediction of outcome in microsurgical clipping of ruptured anterior communicating aneurysm

Background Anatomy of anterior communicating vascular complex is variable and sometimes causes troublesome situations during microsurgical clipping of ruptured anterior communicating (Acom) aneurysms. Preoperative understanding of anatomy, expecting the presence of normal variations, knowing the exa...

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Bibliographic Details
Published in:Egyptian journal of neurosurgery 2021-04, Vol.36 (1), p.1-6, Article 5
Main Authors: Alawamry, Ahmed Mohamed Ehsan, Taha, Mahmoud Mostafa, Abdelbary, Tarek Hassan, Bessar, Ahmed Awad, Farid, Mostafa
Format: Article
Language:English
Subjects:
Accuracy
Aneurysm
Aneurysms
Anterior communicating artery
Computed tomography angiography
Datasets
Iodine
Medical imaging
Medicine
Medicine & Public Health
Neck
Neurosurgery
Surgery
Veins & arteries
Work stations
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Summary:Background Anatomy of anterior communicating vascular complex is variable and sometimes causes troublesome situations during microsurgical clipping of ruptured anterior communicating (Acom) aneurysms. Preoperative understanding of anatomy, expecting the presence of normal variations, knowing the exact aneurysm morphometrics and understanding flow dynamic patterns, help to reach an appropriate surgical outcome. Methods We analyzed the preoperative angiographic anatomical findings in computed tomography angiography and compared them to the intraoperative microscopic anatomical finding in 52 patients who underwent microsurgical clipping of ruptured Acom aneurysms, to reach angiographic prognostic factors in ruptured Acom aneurysm surgery. Results There is statistically significant relation between intraoperative anatomical factors and preoperative CTA findings (closed A2 aneurysm angle, neck extending to A2, anatomical variation, hypoplastic A1, and posterior projection). Conclusion CTA is a reliable method to predict the intraoperative anatomy in Acom aneurysm clipping. Poor outcome was more common among cases with posterior projection, closed A2-aneurysm angle, aneurysm neck extension to A2, and hypoplastic A1.
ISSN:2520-8225
2520-8225
DOI:10.1186/s41984-021-00103-3