Anatomy of anterior communicating vascular complex is variable and sometimes causes troublesome situations during microsurgical clipping of ruptured anterior communicating (Acom) aneurysms. Preoperative understanding of anatomy, expecting the presence of normal variations, knowing the exact aneurysm morphometrics and understanding flow dynamic patterns, help to reach an appropriate surgical outcome. We analyzed the preoperative angiographic anatomical findings in computed tomography angiography and compared them to the intraoperative microscopic anatomical finding in 52 patients who underwent microsurgical clipping of ruptured Acom aneurysms, to reach angiographic prognostic factors in ruptured Acom aneurysm surgery. There is statistically significant relation between intraoperative anatomical factors and preoperative CTA findings (closed A2 aneurysm angle, neck extending to A2, anatomical variation, hypoplastic A1, and posterior projection). CTA is a reliable method to predict the intraoperative anatomy in Acom aneurysm clipping. Poor outcome was more common among cases with posterior projection, closed A2-aneurysm angle, aneurysm neck extension to A2, and hypoplastic A1.

中文翻译：

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术前计算机断层扫描血管造影的解剖学注意事项及其术中解释在预测破裂性前交通动脉瘤的显微外科手术剪裁结果中的作用

前沟通血管复合物的解剖结构是可变的，有时在破裂的前沟通（Acom）动脉瘤的显微外科手术修剪过程中会引起麻烦的情况。术前对解剖结构的了解，期望正常变异的存在，了解确切的动脉瘤形态计量学和了解血流动力学模式，有助于达到适当的手术结果。我们分析了计算机断层扫描血管造影术中的术前血管造影解剖发现，并将其与52例接受了Acom破裂动脉瘤的显微外科手术夹闭术以达到Acom破裂动脉瘤的血管造影预后因素的患者的术中显微解剖发现进行了比较。术中解剖因素与术前CTA表现之间存在统计学上的显着相关性（闭合的A2动脉瘤角度，颈部延伸至A2，解剖学变异，发育不良的A1和后投影）。CTA是预测Acom动脉瘤夹闭术中术中解剖结构的可靠方法。后路突出，闭合的A2动脉瘤角度，动脉瘤颈延伸至A2和发育不良的A1的病例中，较差的预后更为常见。