title: Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients.
abstract: BACKGROUND
  The pterional approach is the most common for AComm aneurysms, but we present a unilateral approach to a midline region for addressing the AComm complex. The pure subfrontal approach eliminates the lateral anatomic dissection requirements without sacrificing exposure. The subfrontal approach is not favored in the US compared to Asia and Europe. We describe our experience with the subfrontal approach for AComm aneurysms treated at a single institution.
  
  
  METHODS
  We identified 28 patients treated for AComm aneurysms through the subfrontal approach. Patient records and imaging studies were reviewed. Demographics and case data, as well as clinical outcome at 6 weeks and 1 year were collected.
  
  
  RESULTS
  Mean patient age was 48 (range 21-75) years and 64% suffered subarachnoid hemorrhage (SAH). All aneurysms were successfully clipped. Gyrus rectus was resected in 57% of cases, more commonly in ruptured cases. Intraoperative rupture occurred in 11% of cases. The average operative time was 171 minutes. There were two patient deaths. Ninety-two percent of patients had a Glasgow Outcome Scale (GOS) of 5 at 6 weeks. All unruptured patients had a GOS of 5. At 12 months, 96% of all patients had a GOS of 5.
  
  
  CONCLUSIONS
  The subfrontal approach provides an efficient avenue to the AComm region, which reduces opening and closing friction but still yields a comprehensive operative window for access to the anterior communicating region.
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
authors: Anthony L
authors: AL
authors: Petraglia
authors: Vasisht
authors: V
authors: Srinivasan
authors: Michael J
authors: MJ
authors: Moravan
authors: Michelle
authors: M
authors: Coriddi
authors: Babak S
authors: BS
authors: Jahromi
authors: G Edward
authors: GE
authors: Vates
authors: Paul K
authors: PK
authors: Maurer