• World Neurosurg · Jan 2025

    Different sides of craniotomy for anteriorly superiorly projecting anterior communicating artery aneurysm clipping: outcome and long-term cognitive function: A single-center retrospective study.

    • Junhui Chen, Ting Wu, Chunlei Zhang, Xu Hu, Jianqing He, Hongqi Zhang, and Yuhai Wang.
    • Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, 45 Changchun St, Beijing, 100053, China; Department of Neurosurgery, 904(th) Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, 214044, China.
    • World Neurosurg. 2025 Jan 23: 123695123695.

    Background And PurposeWe explored the impact of various craniotomy approaches on the outcomes and long-term cognitive function of microsurgical clipping for superiorly projecting anterior communicating artery (ACoA) aneurysms.MethodsWe retrospectively analyzed 127 superiorly projected ACoA aneurysms underwent microsurgical clipping between January 2014 and January 2022. Patients were categorized into two types: type 1 (70 patients), characterized by the posterior positioning of the ipsilateral A2 segment (open A2 plane side), and type 2 (57 patients), characterized by the anterior positioning of the ipsilateral A2 segment (closed A2 plane side). The analysis focused on clinical outcomes (modified Rankin Scale score, mRS) and long-term cognitive function (Montreal Cognitive Assessment, MoCA).ResultsNo significant differences in initial attributes were observed between the two groups. No differences in mRS (P = 0.483), cognitive impairment (P = 0.190), or severe cognitive impairment (P = 0.332) between the two groups. Furthermore, no significant differences in delayed cerebral ischemia (P = 0.852), delayed bleeding (P = 0.912), or intraoperative rupture (P = 0.141) between the two groups. However, the occurrence of MoCA subcategories of postponed memory items (P < 0.05) and conceptualization items (P < 0.05) demonstrated a significant decrease on the accessible A2 plane side during a shorter operative time (P = 0.03) and reduced gyrus rectus aspiration frequency (P = 0.000).ConclusionsThe anterior position of the A2 segment can offer better visualization of the aneurysm dome, bilateral A2, and AcoA, leading to reduced operative time and gyrus rectus aspiration frequency, potentially enhancing long-term cognitive function.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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