Abstract：
Clipping of aneurysms located in the anterior communicating artery (AcomA) is considered a critical surgical procedure for neurosurgeons worldwide because of the complexity of the surgical area. The present study was conducted to discuss the importance of the geometric curvatures and the direction of the dominant A1 artery and their impact on aneurysmal growth direction and choice of side selection of the pterional surgical approach side.
The present study enrolled 183 patients with ruptured AcomA-located aneurysms. The aneurysms were all treated surgically through a pterional approach. Because of multiple dominant A1 directions, we divided the artery into 2 segments, and based on the second segment direction, we categorized the patients into ascending A1, descending A1, and horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, whereas the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms, respectively. A contralateral pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral pterional approach was conducted in the horizontal and descending A1 dominant groups.
The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory inspection of perforators was achieved through the contralateral approach in most cases of an ascending A1, especially if ipsilateral A2 was posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the aneurysmal neck is exposed in ascending A1 geometries.
A1 direction is an important additional factor that is to be considered for side selection when deciding pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from an ipsilateral approach, especially if the ipsilateral A2 was posterior to the neck.
The present study enrolled 183 patients with ruptured AcomA-located aneurysms. The aneurysms were all treated surgically through a pterional approach. Because of multiple dominant A1 directions, we divided the artery into 2 segments, and based on the second segment direction, we categorized the patients into ascending A1, descending A1, and horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, whereas the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms, respectively. A contralateral pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral pterional approach was conducted in the horizontal and descending A1 dominant groups.
The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory inspection of perforators was achieved through the contralateral approach in most cases of an ascending A1, especially if ipsilateral A2 was posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the aneurysmal neck is exposed in ascending A1 geometries.
A1 direction is an important additional factor that is to be considered for side selection when deciding pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from an ipsilateral approach, especially if the ipsilateral A2 was posterior to the neck.
摘要：
目的：由于手术区域的复杂性，夹闭位于前交通动脉（AcomA）的动脉瘤被认为是全世界神经外科医生的关键手术方法。本研究旨在讨论优势A1动脉的几何曲率和方向的重要性及其对动脉瘤生长方向的影响以及翼点手术入路侧面选择的选择。
方法：本研究纳入183例动脉瘤破裂患者。动脉瘤均通过翼点入路手术治疗.由于A1的多个主导方向，我们将动脉分为2段,根据第2段方向将患者分为上升A1,下降A1和水平A1组.上升组包括突出的动脉瘤，而水平组和下降组分别包括前突出动脉瘤和下突出动脉瘤。对于具有升动脉的动脉瘤，选择了优势A1的对侧翼点入路。然而,同侧翼点入路在水平和下降A1优势组中进行。
结果：动脉瘤生长投影轴始终遵循第二个优势A1段的方向。在大多数情况下，尤其是在同侧A2位于颈部后方的情况下，通过对侧方法可以实现对颈部的完全控制和满意的穿孔器检查。在动脉瘤颈暴露于上升的A1几何形状之前，从对侧暴露可以令人满意地看到A1段。
结论：A1方向是决定A1分叉动脉瘤翼点暴露时需要考虑的重要附加因素。与从同侧入路进入相比，进入对侧优势上升A1具有更好的颈部可视化效果，尤其是在同侧A2位于颈部后方的情况下。
方法：本研究纳入183例动脉瘤破裂患者。动脉瘤均通过翼点入路手术治疗.由于A1的多个主导方向，我们将动脉分为2段,根据第2段方向将患者分为上升A1,下降A1和水平A1组.上升组包括突出的动脉瘤，而水平组和下降组分别包括前突出动脉瘤和下突出动脉瘤。对于具有升动脉的动脉瘤，选择了优势A1的对侧翼点入路。然而,同侧翼点入路在水平和下降A1优势组中进行。
结果：动脉瘤生长投影轴始终遵循第二个优势A1段的方向。在大多数情况下，尤其是在同侧A2位于颈部后方的情况下，通过对侧方法可以实现对颈部的完全控制和满意的穿孔器检查。在动脉瘤颈暴露于上升的A1几何形状之前，从对侧暴露可以令人满意地看到A1段。
结论：A1方向是决定A1分叉动脉瘤翼点暴露时需要考虑的重要附加因素。与从同侧入路进入相比，进入对侧优势上升A1具有更好的颈部可视化效果，尤其是在同侧A2位于颈部后方的情况下。
