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Objective: To summary the microsurgical treatment of aneurysms in terms of the direction of the aneurysm and common complications of patients with anterior communicating aneurysms and explore the operation opportunity and treatment of intraoperative aneurysm rupture.Methods: 45 anterior communicating aneurysms cases with different directions undergoing microscopic neurosurgery operation during 2009 to 2011 performed by Pro.Jincao Chen in Tongji Hospital Wu Han were collected.44 cases were proved anterior communicating aneurysms by DSA and CTA preoperatively and 1 case was confirmed the same one after emergency operation. According to the lateral image of the cerebral angiography, the aneurysms were divided into several cases: anteriosuperior case, anterioinferior case, posteriosuperior case, posterioinferior case and complicated case. anteriosuperior case and posteriosuperior case were regarded as the superior case, and the posterioinferior case and anterioinferior case were regarded as the inferior case. And all directions of aneurysms were verified during operations.And the patients,signs and symptoms were taken into consideration postoperatively to assess the prognosis.Results: There were 10,22,6,5,2 cases in terms of Hunt—Hess grades I,II,III,IV and V.45 patients had underwent microscopic neurosurgery operation,and 42 cases had been surgically clipping. Outcomes of all cases were evaluated by GOS when leaving the hospital. There were31,9,3,1,1 and 3 cases in terms of GOS grade 5,4,3,2and 1.And grade 4 and 5 proved perfect outcomes. The good outcome rate were 100%,95.5%(21/22),83.3%(5/6),60%(3/5),50%(1/2)in terms of Hunt—Hess grades I,II,III,IV and V,P<0.05 and significant differences were in place. The good outcome rate were 75%(3/4),91.8%(31/34),85.7 (6/7),P>0.05, and no significant differences were in place. The good outcome rate of the superior case was 64.29%, and the inferior case was 87.10%,P<0.05, and significant differences were in placeConclusion:1. Microsurgical operation was an effective method to treat patients older than 60 years with anterior communicating aneurysms.2. Structures adjacent to anterior communicating aneurysms were complex. It was important to preoperatively analyze angiograms carefully. The directions of aneurysms had impacts on good outcome rate.\3. Adopting pterional approach, choosing the operation time according to patient’s condition and treating intraoperative aneurysm rupture calmly .4. Sufficient attention should be paid to cerebral vasospasm and postoperative hydrocephalus and Active prevention and treatment can improve prognosis.
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