Correlation Between Aneurysm Dome Direction and Patient Outcomes Following Surgery for Ruptured Anterior Communicating Artery Aneurysms

Background Anterior communicating (Acom) artery aneurysms are the most common type of intracranial aneurysms. Despite the enormous advancements in the field of endovascular surgery for intracranial aneurysms, open surgical clipping of aneurysms remains the most durable management of Acom aneurysms. There have been various studies based on the clinical-radiological profile and outcome of open clipping for intracranial aneurysms, but the correlation of the direction of the aneurysm with the surgical outcome remains incompletely defined. Aim To analyze the correlation between the direction of the aneurysm dome and patient outcomes after surgery for ruptured Acom artery aneurysms. Materials and methods CT angiography of the brain was done in all patients pre-operatively as part of the standard treatment protocol. Retrospective data was collected from an inter-departmental computerized database, which included the patient’s details, history, investigations, a course in the hospital from admission to discharge, and an operative note by the surgeon. Prospective data was collected from patients with ruptured Acom artery aneurysms. We analyzed the relationship between the direction of the dome of the Acom aneurysm and preoperative, intraoperative, and postoperative variables. Results Of the 48 patients who underwent surgery for ruptured aneurysms, 34 (70.8%) were female and 14 (29.2%) were male. Among the 27 cases with anteriorly projecting aneurysms, 11 (40.7%) experienced postoperative complications. Of the five cases with posteriorly projecting aneurysms, two (40%) experienced postoperative complications. One-third of cases of the inferior dome direction and 10% of cases of the superior direction of the dome of aneurysm were also found to have postoperative complications. However, using the chi-square test, the association between postoperative complications and the direction of the aneurysm was determined to be statistically non-significant (p-value = 0.93). Conclusion The findings of our investigation indicate that aneurysms with superior projection exhibit the lowest likelihood of experiencing intraoperative rupture. However, it was seen that the outcome was influenced by dome projection throughout the three-month follow-up. The findings of our study indicate that aneurysms with a superior orientation exhibit the least likelihood of experiencing intraoperative rupture.