Interhemispheric approach has been accepted as a standard method approaching distal anterior cerebral artery (DACA) aneurysm. In this approach, most authors use the surgical method retracting the superior sagittal sinus (SSS) after dural
reflection.
However, it results in limited surgical space and makes the surgical procedure difficult technically. To overcome the limitation, we tried to ligate and cut SSS in 13 patients out of 23 patients of DACA aneurysm from Mar. 1983 to Feb. 1993.
Out of total 583 intracranial aneurysms operated on in that period, the proportion of DACA aneurysm was 3.95%. Mean age was 52.7 years ranging from 32 to 66 years. The sex ratio was 7:16, showing female predominancy. As presenting symptoms,
twenty
two
patients had subarachnoid hemorrhage and one patient had a third nerve palsy due to and unruptured pristerior communicating artery aneurysm. On admission, 4 patients (17.4%) were in grade I, 10 (43.5%) in grade II, 6 (26.1%) in grade III, 3 (13%)
in
grade IV according to the Hunt and Hess grading system. In 18 patients (78.3%), aneurysms were located at bifurcation of pericallosal and callosomarginal artery and in 5 (21.7%) at bifurcation of frontopolar and pericallosal artery. Associated
vascular
anomalies were Al hypoplasia (2 case), multiple aneurysms (5 cases), fenestration of anterior cerebral artery (1 case) and arteriovenous malformation (1 case).
Thirteen cases were operated on with ligation of the SSS and 10 without ligation. Overall surgical outcomes scored by Glasgow outcome scale were ; 11 patients (47.8%) in Grade I. 6 (26.1%) in Grade II, 2 (8.7%) in Grade III, 4 (17.4%) in Grade V.
The
outcomes in ligation group were : 8 patients (61.5%) in Grade I, 4(30.8%) in Grade II, 1(7.7%) in Grade III, and no death. The outcomes in non-ligation group were : 4 patients (40%) in Grade I, 1 (10%) in Grade II, 1 (10%) in Grade III, and 4
(40%)
in
Grade V. These results showed that the patients operated on with ligation of SSS had more favorable outcomes than the patients without ligation. It seems that the ligation of SSS in the interhemispheric approach might provide several advantages
and
getter operative outcome over the conventional method.
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