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Neurosurgical Techniques

Aneurysm of the Anterior Communicating Artery*

LYLE A. FRENCH,M.D., SHELLEYN. CHOU,M.D., J~M L. STORY, M.D.,

AND EARL A. SCIIULTZ, M.D.

Division of Neurosurgery, Departmentof Surgery,and Departmentof Anesthesiology, Universityof Minnesota Medical School,Minneapolis, Minnesota

T ItE surgical technique which this report presents has been used on a series of 50 patients with aneurysms in the area of the anterior communicating artery. We h a v e found it an effective method. In essence, it is a direct attack on the aneurysm with an a t t e m p t to obliterate it in its entirety. A general anesthetic is used, the airway being assured with an endotracheal tube. Controlled ventilation is preferred to any r e s p i r a t o r y efforts on the part of the patient. An osteoplastic transfrontal craniotomy is p e r f o r m e d on the right side irrespective of w h e t h e r the a n e u r y s m fills better from the

• Supported in part by the Morris T. Baker Fund for Neurosurgical Research and Training.

left or the right unless there is a left frontal lobe intracerebral hematoma. A coronal (Souttar) scalp incision (:Fig. 1) is made and the scalp reflected. An osteoplastic craniot- o m y is p e r f o r m e d with the inferomedial trephine opening (A) placed over the sagittal sinus and as low as possible without entering the frontal sinus. T h e craniotomy flap need not be excessively large. T h e dura m a t e r is opened in a triangular fashion in the infero- medial p a r t of the cranial opening as shown in Fig. ~. I t is opened medially to the sagittal sinus and as far anteriorly as possible. T h e wings of this flap are sutured to the perios- teum. A wedge-shaped section of anterome- dial frontal lobe is then removed. On the cortical surface, this wedge generally is a b o u t

FIG. 1. The scalp incision and site of eraniotomy. 1058