Surgical management of anterior communicating artery aneurysms based in computed tomographic angiography with three-dimensional reconstruction and without preoperative angiography

Objective. To demonstrate the usefulness of three-dimensional computed tomographic angiography (CT-3D-angiography) in the microsurgical management of aneurysms of the anterior communicating artery (AComA). Materials and Methods. A total of 28 consecutive patients with ruptured aneurysms of the AComA diagnosed by means of CT-3D-angiography and without preoperative angiography were operated on. The findings of the T-3D-angiography, microsurgical exploration and clinical data were evaluated. Results. There were no false positive findings nor false negative findings in the diagnosis of the AComA aneurysms. The global sensibility of the examination was 87.9%. The CT-3D-angiography study shows a left A1 segment dominance in 53.6% of cases, a right A1 dominance in 14.3% of cases and both A1 segments of the same diameter in 32.1%. Aneurysms growing on the traject of the AComA were associated with both A1 segments of the similar diameter and an AComA traject pararell to the transverse plane. Aneurysms implanted on the A1-A2 junction were associated with a dominant homolateral A1 segment and an oblique AComA traject. Microsurgical management of the lesions was done a mean of 3.7 days after bleeding. Conclusion. The study of patients with acute subarachnoid hemorrhage with CT-3D-angiography allows a reliable diagnosis of AComA aneurysms. The examination gives some anatomical data that allow the study of the hemodinamic changes involved in the development of the aneurysms. Moreover, provides usefull information for the microsurgical clipping. CT-3D-angiography allows to improve some health indicators but its impact in the final result of the patients needs more clinical data.