LAUSR

BACKGROUND AND OBJECTIVE The interhemispheric approach (IHA) provides an excellent surgical corridor for clipping anterior communicating artery aneurysms (AcoAA). However, an important disadvantage of the approach is obtaining proximal control at A1 in the last stage of dissection, especially in anterior or superior projecting AcoAA and ruptured cases. The authors describe and evaluate the microsurgical clipping of AcoAA using the IHA with early A1 exposure. METHOD This was a retrospective descriptive study in patients with AcoAA who received microsurgical clipping through the IHA with early A1 exposure between April 2016 and May 2019. Aneurysm morphology, projection, completeness of clipping, surgical complications and outcomes were collected from medical records. RESULT Twenty-five patients with AcoAA received microsurgical clipping via the IHA with early A1 exposure. Twenty-three patients (92%) presented with subarachnoid hemorrhage. Intraoperative rupture while dissecting the interhemispheric fissure occurred in two cases, for which proximal control via subfrontal route was effectively performed. One hundred percent of the patients achieved complete obliteration of their aneurysms. Postoperative anosmia was detected in 22.7%. In ruptured cases, 16 (88.9%) of the good grade patients achieved a good outcome (Glasgow Outcome Score [GOS] of 4, 5) at 3 months after the operation. CONCLUSION The IHA with early A1 is safe and effective for clipping AcoAA.