Comparison of Outcomes for Anterior Communicating Artery Aneurysms Clipped Via a Basal Interhemispheric Approach vs. a Pterional Approach

Introduction: Many approaches for clipping anterior communicating (ACom) artery aneurysms are described in the literature, but controversy remains over the best technique. These techniques can be best divided into lateral (pterional) or interhemispheric. Although the interhemispheric technique has not gained generalized acceptance, we compare our experience between the basal interhemispheric approach and the pterional approach to clipping ACom aneurysms.

Methods: Twenty ACom aneurysms clipped from a basal interhemispheric (BIH) approach are reviewed and compared with 34 ACom aneurysms contemporaneously treated via a pterional approach. The operative, perioperative complications and long-term outcomes are evaluated in a retrospective manner.

Results: Although there was a trend to a younger age in the BIH group (52 years) compared with the pterional group (56 years), there were no statistical differences in the demographics, comorbidities, or aneurysm characteristics. There was no statistical difference in the grade of patients being treated in both groups or in the projection of the aneurysms. Although not statistically significant, patients in the BIH group did tend to have higher Hunt Hess (1.7 vs. 1.2, P = 0.2) and higher Fisher (1.7 vs. 1.2, P = 0.4) scores. There was no statistical difference in the degree of postoperative spasm. In the pterional group, 18% of patients required postoperative ventriculoperitoneal shunts vs. 0% in the BIH group. In the BIH group, there were 2 wound infections, 1 CSF leak, 1 patient with hyposmia, and 1 intraoperative rupture. In the pterional group, there was 1 wound infection, no CSF leak, no hyposmia, and 4 intraoperative ruptures. No patients within the BIH group have required any further aneurysm treatment, compared with 3 patients within the pterional group that have required retreatment due to residual aneurysm.

Conclusion: Although there are increased technical difficulties with the basal interhemispheric approach, we believe that this approach can be used to treat ACom aneurysms with good clinical results. The benefits of this approach include minimal retraction and decreased trauma to the frontal lobes and improved visualization of essential anatomical structures. Our results suggest that the BIH is a safe and feasible option in the treatment of ACom aneurysms and should be considered for all ACom aneurysms.