Abstract
This microsurgical study attempts to analyze the intraoperative anatomic vascular
variations associated with the anterior communicating artery (ACoA) aneurysms in 120
patients who were operated on at the Neurosurgical Department of Atatürk University
Medical School, Erzurum, Türkiye. All patients underwent radical surgery for aneurysm
by the right pterional approach. The findings were recorded during surgical intervention
and through the slides and videotapes of the operations. A total of 72 (60 %) of our
patients had vascular variations in the vicinity of the ACoA. Marked hypoplasia of
the A1 segment of anterior cerebral artery (ACA) at the right or left side (26.6%, n = 32),
median artery of the corpus callosum (MACC) (14%, n = 17), duplication of the ACoA
(8.3%, n = 10), duplication of the A1 segment of ACA (7.5%, n = 9) and azygous pericallosal artery (3.3%, n = 4) were the
variations that were observed during operations. A retrospective study of the cerebral
angiograms of the cases indicated that preoperative diagnosis of the A1 or ACoA duplication was not possible. 14 (82.4 %) of the 17 MACC's were easily identified,
while three (17.6%) could not be diagnosed.
From this intraoperative study, we concluded that, regardless of whether a vascular
variation has been identified preoperatively, ACoA aneurysm surgery should be undertaken
with the possibility of an MACC in mind. The recognition of the anatomic variations
of the ACoA and the detailed knowledge of the microvascular relationships of the aneurysms
will allow the neurosurgeons to construct a better and safer microdis-section plan
to save time on the one hand and to prevent postoperative neurological deficits on
the other.
Key words
Anterior communicating artery - Variation - Aneurysm - Intraoperative study - Microsurgical
anatomy
