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Impact of subcallosal artery origin and A1 asymmetry on surgical outcomes of anterior communicating artery aneurysms

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Surgical clipping of anterior communicating artery (ACoA) aneurysms remains challenging due to their complex anatomy. Anatomical risk factors for ACoA aneurysm surgery require further elucidation. The aim of this study is to investigate whether proximity of the midline perforating artery, subcallosal artery (SubCA), and associated anomaly of the ACoA complex affect functional outcomes of ACoA aneurysm surgery.

Methods

A total of 92 patients with both unruptured and ruptured ACoA aneurysms, who underwent surgical clipping, were retrospectively analyzed from a multicenter, observational cohort database. Association of ACoA anatomy with SubCA origin at the aneurysmal neck under microsurgical observation was analyzed in the interhemispheric approach subgroup (n = 56). Then, we evaluated whether anatomical factors associated with SubCA neck origin affected surgical outcomes in the entire cohort (both interhemispheric and pterional approaches, n = 92).

Results

In the interhemispheric approach cohort, combination of A1 asymmetry and aneurysmal size ≥ 5.0 mm was stratified to have the highest probability of the SubCA neck origin by a decision tree analysis. Then, among the entire cohort using either interhemispheric or pterional approach, combination of A1 asymmetry and aneurysmal size ≥ 5.0 mm was significantly associated with poor functional outcomes by multivariable logistic regression analysis (OR 6.76; 95% CI 1.19–38.5; p = 0.03) as compared with A1 symmetry group in the acute subarachnoid hemorrhage settings.

Conclusion

Combination of A1 asymmetry and larger aneurysmal size was significantly associated with SubCA aneurysmal neck origin and poor functional outcomes in ACoA aneurysm surgery. Interhemispheric approach may be proposed to provide a wider and unobstructed view of SubCA for ACoA aneurysms with this high-risk anatomical variant.

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Data availability

Anonymized data will be shared by request from any qualified investigator.

Code availability

Statistical software application is available in the manuscript.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kochi University Hospital, 185-1, Oko-cho, Kohasu, , Nankoku, Kochi, 783-8505, Japan

    Hitoshi Fukuda, Fumihiro Hamada, Motonobu Nonaka, Yusuke Ueba, Naoki Fukui & Tetsuya Ueba

  2. Department of Neurosurgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-0052, Japan

    Yoshitaka Kurosaki, Minami Uezato, Takaya Yasuda, Masaki Chin & Sen Yamagata

  3. Department of Neurosurgery, Shiroyama Hospital, 2-8-1, Habikino, Habikino, Osaka, 583-0872, Japan

    Jun Morioka & Kenichi Murao

  4. Department of Neurosurgery, Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan

    Masaomi Koyanagi, Norio Nakajima & Keisuke Yamada

  5. Department of Neurosurgery, Kochi Health Sciences Center, 2125-1, Ike, Kochi, Kochi, 781-8555, Japan

    Tsuyoshi Ohta

  6. Department of Neurological Surgery, Lenox Hill Hospital, 100 East 77th St, New York, NY, 10075, USA

    Benjamin Lo

Authors
  1. Hitoshi Fukuda
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  2. Fumihiro Hamada
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  3. Motonobu Nonaka
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  4. Yusuke Ueba
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  5. Naoki Fukui
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  6. Yoshitaka Kurosaki
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  7. Jun Morioka
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  8. Masaomi Koyanagi
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  9. Norio Nakajima
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  10. Minami Uezato
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  11. Takaya Yasuda
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  12. Masaki Chin
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  13. Sen Yamagata
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  14. Kenichi Murao
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  15. Keisuke Yamada
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  16. Tsuyoshi Ohta
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  17. Benjamin Lo
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  18. Tetsuya Ueba
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Contributions

Conception and design: Fukuda, Ohta. Acquisition of data: Hamada, Nonaka, Ueba Y, Fukui, Kurosaki, Morioka, Koyanagi, Nakajima, Uezato, Yasuda, Chin, Murao. Analysis and interpretation of data: Fukuda, Koyanagi, Ohta. Drafting the article: Fukuda, Lo. Critically revising the article: all authors. Reviewed submitted version of the manuscript: all authors. Statistical analysis: Fukuda, Lo. Administrative/technical/material support: Hamada, Nonaka, Fukui, Kurosaki, Morioka, Koyanagi, Yamagata, Murao, Yamada. Study supervision: Yamagata, Murao, Yamada, Ueba T.

Corresponding author

Correspondence to Hitoshi Fukuda.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Kochi University Hospital Research Ethics Committee (Kochi, Japan) (#31–13), and waiver of consent was sought and obtained for this observational study with no unique patient identifiers.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Vascular Neurosurgery—Aneurysm

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Fukuda, H., Hamada, F., Nonaka, M. et al. Impact of subcallosal artery origin and A1 asymmetry on surgical outcomes of anterior communicating artery aneurysms. Acta Neurochir 163, 2955–2965 (2021). https://doi.org/10.1007/s00701-021-04979-w

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  • DOI: https://doi.org/10.1007/s00701-021-04979-w

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