Value of three-dimensional DSA simulation for the side selection of pterional approach to clip anterior communicating artery aneurysms / 中国脑血管病杂志

ABSTRACT

Objective To evaluate the safety and efficiency of the treatment strategy based on three-dimensional digital subtraction angioplasty (3 D-DSA) for the side selection of pterional approach to clip anterior communicating artery aneurysm. Methods All 75 continuous patients with single anterior communicating artery aneurysm(Hunt-Hess 0-III grade) treated by microsurgical clipping via the pterional approach were analyzed retrospectively. The side selection of approach was based on 3D-DSA. All patients' gender, age, Hunt-Hess grade, aneurysm size, the side of approach, complications, the length of postoperative stay, the ratio of complete occlusion, and the Glasgow outcome scale (GOS) score at discharge were collected. The ratio of complete occlusion and clinical outcome were analyzed according to the group of left or right approach and different Al dominant approach. Results (1) Fifty-six patients (74. 7%) were left Al dominants, with 30 of those treated via the left-side approach and 26 of those treated via the right-side approach. Nineteen patients (25.3%) were right Al dominants, with 15 of those treated via the right-side approach and 4 of those treated via the left-side approach. (2) Surgical exposure of all aneurysms was satisfactory during operation, which was consistent with the 3D-DSA image simulation before the operation. The median length of postoperative stay was 9(8, 11) days. Six patients(8. 0%) suffered symptomatic cerebral infarction, and 1 patient (1.3%) had an intracranial infection. Sixty-five cases performed DSA or CT antigraphy after the operation. Sixty-two aneurysms (95.4%) were completely clipped and 3 aneurysms (4.6%) existed residual segments in the neck of the aneurysm. Sixty-nine patients (92.0%) reached 5 grade of GOS, 3 patients (4.0%) reached 4 grade of GOS, 3 patients (4.0%) reached 3 grade of GOS, and no patient was below 3 grade of GOS at discharge. (3) The surgical-related complications, clipping results, hospital-stay time after operation, and GOS at discharge were insignificantly different between left and right side approach, also insignificantly different between the dominant Al side and contralateral side approach. Conclusion The treatment strategy, based on preoperative 3D-DSA imaging simulation for the side selection of pterional approach to clip anterior communicating artery aneurysms, was safe and effective.