Anterior communicating artery aneurysms : the direction of aneurysm and its bearing on surgical outcome.

A series of 44 consecutive patients with aneurysms of anterior communicating (A. Com.) artery during an 8 year period, during which 80 patients with 91 aneurysms were operated, is being reported. It comprised 55.0 percent of all aneurysms operated during this period. Eight patients (18.2 percent) had multiple aneurysms. Twenty seven A.Com. aneurysms (61.4 percent) were directed anteroinferiorly, 8 aneurysms (18.2 percent) posterosuperiorly, 6 aneurysms (13.6 percent) superiorly and 3 aneurysms to the side. Twenty nine. A.Com. Aneurysms (65.9 percent) arose at dominant A1-A.Com. junction. All cases were treated by direct surgery. The results are encouraging, though mortality overall was 15.9 percent. Good grade cases made satisfactory recovery. Direction of aneurysm at AC-A.com. and its bearing on surgical outcome is stressed. Most of the posterosuperior pointing aneurysms presented in poorer grades and outcome was unsatisfactory. In comparison most of anteroinferiorly pointing aneurysms presented better grades and results were satisfactory.