Relationship between Gyrus Rectus Resection and Cognitive Impairment after Surgery for Ruptured Anterior Communicating Artery Aneurysms

OBJECTIVE: The gyrus rectus (GR) is known as a non-functional gyrus; hence, its resection is agreed to be a safe procedure frequently practiced to achieve a better surgical view during specific surgeries. This study aimed at comparing the cognitive outcomes following GR resection in patients who underwent surgery for ruptured anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS: From 2012 to 2015, 39 patients underwent surgical clipping for ruptured ACoA aneurysms. Mini-mental state examinations (MMSE) were performed in 2 different periods. The statistical relationship between GR resection and MMSE results was evaluated, and further analysis of MMSE subgroup was performed. RESULTS: Twenty-five out of the 39 patients (64.19%) underwent GR resection. Mean initial and final MMSE scores in the GR resection group were 16.3 ± 9.8 and 20.8 ± 7.3, respectively. In the non-resection group, the mean initial and final MMSE scores were 17.1 ± 8.6 and 21.9 ± 4.5, respectively. Neither group's scores showed a significant change. Subgroup analysis of initial MMSE showed a significant difference in memory recall and language (p = 0.02) but not in the final MMSE scores. CONCLUSION: There was no significant relationship between the GR resection and cognitive outcomes in terms of total MMSE scores after surgery for ruptured ACoA aneurysm. However, subgroup analysis revealed a temporary negative effect of GR resection in the categories of language and memory recall. This study suggests that GR resection should be executed superficially, owing to its close anatomical relationship with the limbic system.

Results of Direct Intracranial Surgery and Classification for 135 Anterior Communicating Artery Aneurysms

During the 10-year period up to December 1984, 176 patients with anterior communicating aneurysn(ACOMA) among total 467 patients of intracranial aneurysms were admitted to this Catholic Medical Center. Of these, 135 cases of ACOMA were operated by direct intracranial procedures. To analyse the factors influencing the mortality involving in surgery of 135 patients with ACOMA, a classification of ACOMA was attempted. The origins and projections of aneurysms, anatomical variations were analysed with the aid of angiography, intraoperative findings and intraoperative photographs which permitted the establishment of a classification of ACOMA with their direction. Our classification of operated 135 cases of ACOMA are seven types : 32 anterior(23.7%), 30 anterior-rostral(22.2%), 42 antefior-caudal(31.1%), 3 posterior(2.2%), 18 posterior-rostral(13.4%), 4 posteriorcaudal(3.0%), caudal 6(4.4%), respectively. Most of ACOMA projecting anteriorly, anterio-rostrally were situated above or between the optic nerve, and the less frequent posterior-caudal and inferior aneurysms were in close proximity to hypothalamic branches of the anterior communicating artery and A2 segment. There was on overall operative mortality of 6%. The surgical morbidity and mortality were significantly higher in the posteriorly projecting group, garticulary in the posterior-caudal direction. In direct surgery of ACOMA, subpial resection of the gyrus rectus was effective for not only anteriorly, but also posteriorly directing aneurysms.

Technical Consideration in Clipping of the Anterior Communicating Aneurysms: The Gyrus Rectus Approach, Report of Two Operative Cases

The anterior communicating artery(Acomm) is one of more common sites of intracranial aneurysms. Surgery of anterior communicating aneurysm has been considered difficult because it is deep, and proximity to the vital diencephalic centers and it projects in various directions and its parent artery is thin or thourgh the sac, sometimes having vascular anomalies. Successful treatment of aneurysms by intracranial surgery requires careful planning of the surgical approach. The gyrus rectus approach to anterior communicating aneurysms is based on the belief that since aneurysms rupture at their fundus they can most safely be approached at their base because premature rupture of an aneurysm is deleterious to appropriate surgical treatment. From January to October 1982, 20 cases with ruptured aneurysms of the Acomm have been operated on using microsurgical procedures. We have presented 2 patients of Acomm aneurysms with certain difficult in clipping neck. The double aneurysms were obliterated with two clips and the other aneurysm was clipped with the long length clip and also the inclusion of adjacent vital nerves and vessels in the clips were avoided. Technical problems associated with the application of the clips are discussed.