Results of surgical treatment of aneurysms of the anterior cerebral communicating complex

Authors

Keywords:

craniotomy, intracranial aneurysm, microsurgery, subarachnoid hemorrhage

Abstract

Introduction: Aneurysms of the communicating artery of the anterior cerebral artery are common vascular lesions. Microsurgical isolation of the aneurysm presents a significant challenge due to the complex and closely related neurovascular structures.

Objective: To describe the surgical results of anterior cerebral artery communicating complex aneurysms operated on using microsurgical clamping.

Method:  A descriptive, prospective study was carried out that included 79 aneurysm sacs f operated on for aneurysms of the communicating complex of the anterior brain by microsurgical clipping. Pterional and minipterional craniotomy and clamping of the aneurysm were performed. Clinical, cerebral aneurysm and postoperative variables were used with greater importance related to complications and the Glasgow Coma Scale for results. For data analysis, absolute and relative frequencies were used as summary measures.

Results: There was a predominance of patients with clinical evaluation using the World Federation of Neurosurgical Societies Scale II (59.3%) and a Fisher scale score of 3 on imaging (53.1%). Regarding the aneurysm status, 81.1% were unruptured. Aneurysm clamping was performed in 100% of cases. The main complication was pneumonia (8.8%). According to the Glasgow Outcome Scale, grade 5 was the most prevalent score (79.7%).

Conclusions:  Microsurgical clipping in patients with aneurysms of the anterior cerebral communicating complex was accompanied by good surgical results and few complications, with extra-neurological complications predominating.

Downloads

Download data is not yet available.

Author Biography

Carlos Roberto Vargas Gálvez, Hospital Hermanos Ameijeiras. Servicio de Neurocirugía. La Habana, Cuba.

Neurocirujano, servicio de Neurocirugía del hospital Clínico Quirúrgico Hermanos "Ameijeiras"

References

1. Jacquens A, Shotar E, Bombled C, Glémain B, Sourour NA, Nouet A, et al. Is Anatomical Variations a Risk Factor for Cerebral Vasospasm in Anterior Communicating Complex Aneurysms Rupture [Internet]. Stroke. 2020; 51(3):998-1001. DOI: 10.1161/STROKEAHA.119.026661

2. Orakdogen M, Mammadkhanli O, Chousein B, Simsek O. Development of a comprehensive and clinically applicable novel projection classification system for anterior communicating artery aneurysms [Internet]. Neurosurg Rev. 2024; 47(1):39. DOI: 10.1007/s10143-023-02275-y

3. López-Sala P, Alberdi N, Mendigaña M, Bacaicoa MC, Cabada T. Anatomical variants of anterior communicating artery complex. A study by Computerized Tomographic Angiography [Internet]. J Clin Neurosci. 2020; 80:182-7. DOI: 10.1016/j.jocn.2020.08.019

4. Pietrantonio A, Trungu S, Delfini R, Raco A. Microsurgical Treatment of Anterior Communicating Artery Aneurysms: A 20-year Single-institution Experience [Internet]. J Neurol Surg A Cent Eur Neurosurg. 2020; 81(1):33-43. DOI: 10.1055/s-0039-1685507

5. Nussbaum ES, Touchette JC, Madison MT, Goddard JK, Lassig JP, Nussbaum LA. Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature [Internet]. Oper Neurosurg (Hagerstown). 2020; 19(6):678-90. DOI: 10.1093/ons/opaa214

6. Schwandt E, Kockro R, Kramer A, Glaser M, Ringel F. Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system [Internet]. Neurosurg Rev. 2022; 45(4):2887-94. DOI: 10.1007/s10143-022-01794-4

7. McEachern J, Iancu D, van Adel B, Drake B, Kaderali Z, Spirou M, et al. Long term safety and effectiveness of LVIS Jr for treatment of intracranial aneurysms- a Canadian Multicenter registry [Internet]. Interv Neuroradiol. 2023; 29(2):134-40. DOI: 10.1177/15910199221077588

8. Takeuchi M, Uyama A, Matsumoto T, Tsuto K. Endovascular Treatment for Anterior Communicating Artery Aneurysms [Internet]. Adv Tech Stand Neurosurg. 2022; 44:239-49. DOI: 10.1007/978-3-030-87649-4_13

9. Amuluru K, Al-Mufti F, Romero CE. Flow diversion treatment of anterior communicating artery region aneurysms [Internet]. J Neuroradiol. 2021; 48(5):391-6. DOI: 10.1016/j.neurad.2019.06.002

10. Diana F, Pesce A, Toccaceli G, Muralidharan V, Raz E, Miscusi M, et al. Microsurgical clipping versus newer endovascular techniques in treatment of unruptured anterior communicating artery-complex aneurysms: a meta-analysis and systematic review [Internet]. Neurosurg Rev. 2022; 45(2):1089-100. DOI: 10.1007/s10143-021-01647-6

11. Wójtowicz K, Przepiorka L, Kujawski S, Marchel A, Kunert P. Aneurismas no rotos de la arteria comunicante anterior: Estrategia de manejo y resultados de un estudio en un solo centro [Internet]. J Clin Med. 2023;12(14):4619. DOI: 10.3390/jcm12144619

12. Gorbatykh A, Kislitsin D, Shayakhmetov T, Seleznev P, Berestov V, Strelnikov N, et al. Desvío de flujo versus espiralado en aneurismas pequeños y medianos no rotos de la circulación proximal anterior con anatomía compleja: un estudio de pares emparejados [Internet]. Clin Neuroradiol. 2025; 35(4):659-67. DOI: 10.1007/s00062-025-01518-3

13. Rahme RJ, Patra DP, Turcotte EL, Bendok BR. Microsurgical Clipping of a Postcoiling, Residual or Recurrent, Ruptured Anterior Communicating Artery Aneurysm [Internet]. World Neurosurg. 2022; 161:153. DOI: 10.1016/j.wneu.2021.05.010

14. Nguyen TA, Mai TD, Vu LD, Dao CX, Ngo HM, Hoang HB, et al. Validación de la precisión de la escala de clasificación de hemorragia subaracnoidea modificada de la Federación Mundial de Sociedades de Neurocirugía para predecir los resultados de pacientes con hemorragia subaracnoidea aneurismática [Internet]. PLoS One. 2023;18(8):e0289267. DOI: 10.1371/journal.pone.0289267

15. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale [Internet]. Neurosurgery. 2006; 59(1):21-7. DOI: 10.1227/01.neu.0000243277.86222.6cV

16. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale [Internet]. J Neurol Neurosurg Psychiatry. 1981; 44(4):285-93. DOI: 10.1136/jnnp.44.4.285

17. Yasargil MG. Interfascial pterional (frontotemporosphenoidal) craniotomy. Vol. 1. In: Yasargil MG (ed): Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984.p. 215-20

18. Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, Spetzler RF, et al. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms [Internet]. J Clin Neurosci. 2016; 27:34-9. DOI: 10.1016/j.jocn.2015.07.032

19. Osiowski A, Stolarz K, Osiowski M, Klepinowski T, Taterra D. The prevalence and anatomy of recurrent artery of Heubner: a meta analysis with neurosurgical considerations [Internet]. Acta Neurochir (Wien). 2024; 166(1):431. DOI: 10.1007/s00701-024-06327-0

20. Sharma S, Krishna H, Dixit SG, Nayyar AK, Khera P, Ghatak S. Revisión sistemática del análisis morfométrico de la arteria cerebral anterior (ACA) con énfasis en sus implicaciones clínicas [Internet]. Cureus. 2023;15(4):e37744. DOI: 10.7759/cureus.37744

21. Pescatori L, Grasso G, Tropeano MP, Torregrossa F, Santoro G, Ciappetta P. Management of Complex Cerebral Aneurysms [Internet]. World Neurosurg. 2022; 159:266-75. DOI: 10.1016/j.wneu.2021.11.077

22. Zhang XJ, Gao BL, Hao WL, Wu SS, Zhang DH. Presence of Anterior Communicating Artery Aneurysm Is Associated With Age, Bifurcation Angle, and Vessel Diameter [Internet]. Stroke. 2018; 49(2):341-7. DOI: 10.1161/STROKEAHA.117.019701

23. Nussbaum ES, Touchette JC, Madison MT, Goddard JK, Lassig JP, Nussbaum LA. Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature [Internet]. Oper Neurosurg (Hagerstown). 2020; 19(6):678-90. DOI: 10.1093/ons/opaa214

24. Zhang Y, Zhou G, Liu W, Gu W, Zhu Y, Meng L, et al. Analysis of Risk Factors for Anterior Communicating Artery Aneurysm Rupture: A Single-Center Study [Internet]. World Neurosurg. 2021; 153:e59-e65. DOI: 10.1016/j.wneu.2021.06.007

25. Fredon F, Baudouin M, Hardy J, Kouirira A, Jamilloux L, et al. An MRI study of typical anatomical variants of the anterior communicating artery complex [Internet]. Surg Radiol Anat. 2021; 43(12):1983-8. DOI: 10.1007/s00276-021-02782-x

26. Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, et al. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries [Internet]. World Neurosurg. 2021; 154:e155-e162. DOI: 10.1016/j.wneu.2021.06.151

27. Xu F, Bambakidis NC. Microsurgical Clipping of Ruptured Anterosuperior-Projecting Anterior Communicating Artery Aneurysms: How We Do It [Internet]. World Neurosurg. 2018;116:133-135. DOI: 10.1016/j.wneu.2018.05.070

28. Szatkowska I, Szymańska O, Grabowska A. The role of the human ventromedial prefrontal cortex in memory for contextual information [Internet]. Neurosci Lett. 2004; 364(2):71-5. DOI: 10.1016/j.neulet.2004.03.084

29. Gupta A, Tripathi M, Umredkar AA, Chauhan RB, Gupta V, Gupta SK. Impact of Postoperative Infarcts in Determining Outcome after Clipping of Anterior Communicating Artery Aneurysms [Internet]. Neurol India. 2020; 68(1):132-40. DOI: 10.4103/0028-3886.279675

Downloads

Published

2026-01-17

How to Cite

1.
Elizondo Barriel LM, Mapolón Román E, López Arbolay O, Vargas Gálvez CR, Ortiz Machín MM. Results of surgical treatment of aneurysms of the anterior cerebral communicating complex. Rev. cuba. med. mil [Internet]. 2026 Jan. 17 [cited 2026 Jan. 21];55(1):e025076806. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/76806

Issue

Vol. 55 No. 1 (2026): January - March (In progress)

Section

Clinical Practice Article

License

Copyright (c) 2026 Luis Manuel Elizondo Barriel, Eddy Mapolón Román, Omar López Arbolay , Carlos Roberto Vargas Gálvez, Marlon Manuel Ortiz Machín

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who have publications with this Journal accept the following terms:

  • The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
  • The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
  • Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.