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J Neurol Surg B Skull Base 2021; 82(S 03): e211-e216
DOI: 10.1055/s-0040-1710517
Original Article

Partial Gyrus Rectus Resection as a Technique to Improve the Exposure to the Anterior Communicating Artery Complex through the Junctional Triangle: A Quantitative Study

Daniel Valli
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Xiaochun Zhao
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Evgenii Belykh
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
2   Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
,
Qing Sun
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
3   Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
,
Michael T. Lawton
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Mark C. Preul
1   Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
› Author Affiliations Funding This study was supported by funds from the Newsome Chair in Neurosurgery Research held by Dr. Preul and by the Barrow Neurological Foundation.
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Abstract

Objective The junctional triangle, formed by the distal A1 anterior cerebral artery (ACA) segment, the proximal A2 ACA segment, and the medial surface of gyrus rectus (GR), is a corridor of access to superiorly and posteriorly projecting anterior communicating artery (AComA) aneurysms that is widened by GR retraction or resection. Exposure of the AComA complex through the junctional triangle after GR resection has not been previously quantitatively evaluated.

Design GR resection extent and increase in artery exposure through the junctional triangle were assessed in this study.

Setting This study was conducted in the laboratory with a pterional approach, exposing the AComA complex.

Participants Ten sides of five cadaveric heads were considered.

Main Outcome Measures Exposure extent of ipsilateral and contralateral A1, A2, and AComA and accessibility of branches coming off the AComA complex were measured before and after GR resection. The GR was resected until sufficient bilateral A2 and contralateral A1 exposures were achieved. GR resection span was measured.

Results The mean (standard deviation) resected span of GR was 7 ± 3.9 mm. After GR resection, the exposed span of the ipsilateral A2 increased from 2 ± 0.7 mm to 4 ± 1.1 mm (p = 0.001); contralateral A2 exposure increased from 3 ± 1.5 mm to 4 ± 1.1 mm (p = 0.03). Contralateral recurrent artery of Heubner (RAH) and orbitofrontal artery were accessible in five and eight specimens, respectively, before GR resection and in all 10 after resection.

Conclusion GR resection improves exposure of bilateral A2 segments through the junctional triangle. Exposure improvement is greater for the ipsilateral A2 than contralateral A2. The junctional triangle concept is enhanced by partial GR resection during surgery for superior and posterior AComA aneurysms.

Keywords

anatomy - anterior communicating artery - anterior communicating artery aneurysm - gyrus rectus - junctional triangle - pterional - quantitative assessment


Publication History

Received: 12 August 2019

Accepted: 17 March 2020

Article published online:
05 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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