Early Surgery of Anterior Communication Artery Aneurysms

The timing of aneurysm surgery has been a topic of major neurosurgical controversy.

Aneurysmal rebleeding is the most cataclysmic and disabling event following initial subarachnoid hemorrhage. Thus, early surgical obliteration of aneurysm eliminates the potential for rebleeding during the highest risk period.

The results of operation for the twenty-three patients who had admitted to neurosurgical departments, Mokdong hospital and undergone surgery within the 24-72 hours after initial rupture of these aneurysms from October, 1993 to August, 1996, were reviewed.

Twenty-three patients underwent craniotomy for clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, and hemodilution therapy. The outcome was excellent in 10(43%), good in 3(13%), poor in 5(22%) and death in 5(22%). The mean age was 57.7 and the ratio of male to female was 13:10. The outcome according to Hunt-Hess(H-H) grade was followings. H-H grade 1 was 2(%) and all excellent outcome, H-H grade 2 24(61%) and the outcome were excellent in 8(35%), good in 1(4%), poor in 2(9%), death in 3(13%), H-H grade 3 was 6(26%) and good in 2(9%), poor in 2(9%), death in 2(9%), and H-H grade 4 was 1(4%) and the outcome was poor in 1(4%). The outcome according to grading system of Fisher was followings. Grade 2 was 6(26%), and the outcome was excellent in 5(22%) and death in 1(4%). The grade 3 was 14(61%) and excellent in 5(22%), good in 2(9%), poor in 3(13%), and death in 1(4%). The grade 4 was 3(31%) and good in (4%) and poor in 2(9%). The variations in anterior communicating complex were followings. The both A₁ equal in 6(26%), left A₁ dominancy was 1(4%), right A₁ atresia was 13(57%) and left atresia was 3(13%).

The most favorable outcomes and lowest mortality rate were patients of H-H grade 1 group. The surgical results of alert patients with early surgery should even further improve as compared to delay surgery. However, patients who present in poor medical condition at the time of operation were still indicated delay surgery.