Immediate results of microsurgical clipping of posterior communicating artery aneurysms using the pretemporal transclinoidal approach

Background: We evaluated adverse ischemic events as early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery (PComA) aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between January 2007 and October 2010. Methods: Patients undergoing PComA aneurysm clipping were divided into two groups, and their immediate surgical results were compared and analyzed. Those who underwent the pterional transsylvian approach (group A) comprised 42 patients with 44 PComA aneurysms (24 ruptured and 20 unruptured). Those who underwent the pretemporal transclinoidal approach (group B) comprised 32 patients with 34 PComA aneurysms (20 ruptured and 14 unruptured). Results: The immediate postoperative total occlusion rates were 97.7% in group A and 100% in group B. The pretemporal transclinoidal approach significantly reduced the overall risk of silent and symptomatic ischemic strokes (p = 0.04) in ruptured PComA clippings and tended to lower the incidence of intraoperative aneurysm rupture (p = 0.07) as well as the overall ischemic events (p = 0.06) in a total of 78 aneurysm clippings, as compared with the pterional transsylvian approach. Although not significantly, the pretemporal transclinoidal approach also tended to have a lower incidence of intraoperative aneurysm rupture in ruptured aneurysm clippings (p = 0.11), which were mainly responsible for the symptomatic ischemia. The pretemporal transclinoidal approach had no additional advantage over the traditional pterional transsylvian approach in unruptured PComA aneurysm clippings in the present study. Conclusion: The pretemporal transclinoidal approach achieved better visualization of the vital neurovascular structures surrounding PComA aneurysms, which might be a key improvement in lowering the risk of intraoperative aneurysm rupture and obtaining significantly satisfactory immediate surgical results in the microsurgical clipping of PComA aneurysms, especially ruptured ones. Copyright (C) 2012 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.