الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 184 |  |  |
| | | from | 184 | | |
Abstract
In the present series, 32 patients underwent operation for ruptured aneurysm of the anterior communicating artery. The mortality rate was 12.5%. The 29 survived patients have good outcome of 82.2% at the end of follow up period. Patients with severe disability and moderate disability are 3.6% and 14.3% respectively. The successful operation of these aneurysms demands a thorough knowledge of the relationships of the aneurysm to the cisternal anatomy and to neighboring arteries and veins. These anatomical relationships are complex and many anomalies and variations have been described. Important factors include the exact location of the aneurysm, the projection and complexity of the fundus, the relationship of the 14 arteries or groups of arteries around the anterior cerebral-anterior communicating artery junction and the aneurysm, and the anomalies of the At segment, anterior communicating artery and A2 segments of the anterior cerebral arteries. Operation is performed through a pterional craniotomy with removal of bone from the base of the skull and dissection through the subarachnoid cisterns. A general guide to the operation has been given with the qualification that each operation must to some degree be tailored to a particular set of circumstances. In this study , the major limiting factor was its small sample size. For that reason, the preoperative, intraoperative, and postoperative parameters failed to statistically significant. The aim in microneurosurgical management of an ACoA aneurysms is total occlusion of the aneurysm sac with preservation of flow in all branching and perforating arteries.in the present series the rate of aneurysm rebleeding and reformation was less than other surgical series due to the small sample size. By the end of this study, it is highly recommended to manage the cases of ruptured aneurysms by a dedicated neurovascular team that compose a neurosurgeon, neurointerventionalist, and neurocritical care internist. Using hybrid theaters will be the best interest for the patient. At present, not all ACoA aneurysms can be coiled, even given the advent of stent/coil strategies. Therefore, the technique of microsurgical clipping is important for the management of ACoA aneurysms.