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The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory

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

Purpose

An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes.

Methods

The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients’ demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated.

Results

Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99; \(p = 0.022\)), previous stroke (OR, 3.89; \(p = 0.009\)), posterior projection (OR, 5.58; \(p < 0.001\)), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm; \(p = 0.002\)), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm; \(p < 0.001\)) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88; \(p = 0.041\)). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction (\(p = 0.001\)).

Conclusion

Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.

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Data availability

Data is available upon reasonable request.

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Funding

This research was supported by the Korea government Ministry of Science and ICT (MSIT) (2020R1C1C1004365) and 2020IP0017 from the Asan Institute for Life sciences, Asan Medical Center (Seoul, Republic of Korea).

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  1. Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, South Korea

    Hyun Taek Rim, Jae Sung Ahn, Jung Cheol Park, Joonho Byun, Seungjoo Lee & Wonhyoung Park

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hyun Taek Rim, Jae Sung Ahn, Jung Cheol Park, Joonho Byun, Seungjoo Lee, and Wonhyoung Park. The first draft of the manuscript was written by Hyun Taek Rim, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Rim, H.T., Ahn, J.S., Park, J.C. et al. The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory. Acta Neurochir 165, 501–515 (2023). https://doi.org/10.1007/s00701-023-05487-9

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