{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:01:47Z","timestamp":1780131707932,"version":"3.54.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Choosing the side of approach (SoA) in the microsurgical treatment of anterior communicating artery (AComA) aneurysms remains a topic of debate. The aim of this study was to investigate the effectiveness of the open A2 plane as the decisive factor in choosing the SoA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed data from 59 patients who underwent microsurgical treatment for AComA aneurysms from 2017 to 2024 at a single institution. For 19 patients, the SoA was dictated by an accompanying pathology such as another aneurysm or intracerebral hemorrhage. For 40 patients, the open A2 plane was determined due to the location of the ipsilateral A2 by preoperative 3D CTA or DSA. Every patient was evaluated with DSA postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In superior, anterior, and inferior projecting aneurysms, the posteriorly situated A2 determined the side of the open A2 plane, and in posterior projecting aneurysms, the anteriorly situated A2 directed the approach. Right-sided or left-sided craniotomies were performed for 28 and 12 patients, respectively. The SoA was contralateral to the dominant A1 for 50% of patients, ipsilateral to the dominant A1 for 25%, and there was equal A1 flow for 25% of patients. Two patients, both with inferior orienting aneurysms, experienced early aneurysm rupture. Postoperative DSA showed total neck clipping in 37 of 40 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Choosing the SoA based on the open A2 plane facilitated exposure of the aneurysm neck, with high rates of aneurysm closure via a less complicated clip construction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.focus25670","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:25:21Z","timestamp":1764595521000},"page":"E6","source":"Crossref","is-referenced-by-count":0,"title":["Significance of the open A2 plane in determining the side of approach for microsurgical treatment of anterior communicating artery aneurysms"],"prefix":"10.3171","volume":"59","author":[{"given":"Baris","family":"Kucukyuruk","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Cerrahpa\u015fa Faculty of Medicine, Istanbul University \u2013 Cerrahpa\u015fa, Istanbul, Turkiye;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick H. G. J.","family":"van Lanen","sequence":"additional","affiliation":[{"name":"Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands; and"},{"name":"Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Karaboga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cerrahpa\u015fa Faculty of Medicine, Istanbul University \u2013 Cerrahpa\u015fa, Istanbul, Turkiye;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Metin","family":"Kafadar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cerrahpa\u015fa Faculty of Medicine, Istanbul University \u2013 Cerrahpa\u015fa, Istanbul, Turkiye;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galip Zihni","family":"Sanus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cerrahpa\u015fa Faculty of Medicine, Istanbul University \u2013 Cerrahpa\u015fa, Istanbul, Turkiye;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Stroke","first-page":"3018","article-title":"Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms","volume":"44","author":"Bijlenga P","year":"2013","unstructured":"Bijlenga P, Ebeling C, Jaegersberg M,  Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms. Stroke. 2013;44(11):3018\u20133026."},{"issue":"26","key":"b2","series-title":"N Engl J Med","first-page":"2474","article-title":"The natural course of unruptured cerebral aneurysms in a Japanese cohort","volume":"366","author":"Morita A","year":"2012","unstructured":"Morita A, Kirino T, Hashi K,  The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474\u20132482."},{"key":"b3","series-title":"Microneurosurgery. Vol II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results","article-title":"Anterior cerebral and anterior communicating artery aneurysms","author":"Ya\u015fargil MG","year":"1984","unstructured":"Ya\u015fargil MGAnterior cerebral and anterior communicating artery aneurysms. In: Ya\u015fargil MG, ed Microneurosurgery. Vol II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. Thieme;1984."},{"issue":"5 Suppl 2","key":"b4","series-title":"Neurosurgery","first-page":"273","article-title":"Microsurgical management of anterior communicating artery aneurysms","volume":"61","author":"Sekhar LN","year":"2007","unstructured":"Sekhar LN, Natarajan SK, Britz GW, Ghodke BMicrosurgical management of anterior communicating artery aneurysms. Neurosurgery. 2007;61(5 Suppl 2):273\u2013292."},{"issue":"1","key":"b5","series-title":"Surg Neurol","first-page":"8","article-title":"Microneurosurgical management of anterior communicating artery aneurysms","volume":"70","author":"Hernesniemi J","year":"2008","unstructured":"Hernesniemi J, Dashti R, Lehecka M,  Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol. 2008;70(1):8\u201328."},{"issue":"4","key":"b6","series-title":"Neurol Res","first-page":"273","article-title":"Surgical approaches to the anterior communicating artery aneurysm and their results","volume":"15","author":"Diraz A","year":"1993","unstructured":"Diraz A, Kobayashi S, Toriyama T, Ohsawa M, Hokama M, Kitazama KSurgical approaches to the anterior communicating artery aneurysm and their results. Neurol Res. 1993;15(4):273\u2013280."},{"key":"b7","series-title":"Front Neurol","first-page":"1020","article-title":"Anterior communicating artery aneurysms: anatomical considerations and microsurgical strategies","volume":"11","author":"Chen J","year":"2020","unstructured":"Chen J, Li M, Zhu X,  Anterior communicating artery aneurysms: anatomical considerations and microsurgical strategies. Front Neurol. 2020;11:1020."},{"key":"b8","series-title":"Seven Aneurysms","article-title":"Anterior communicating artery aneurysms","volume":"94","author":"Lawton MT","year":"2011","unstructured":"Lawton MTAnterior communicating artery aneurysms. In: Lawton MT, ed. Seven Aneurysms. Georg Thieme Verlag;2011:94."},{"issue":"4 Suppl","key":"b9","series-title":"Neurosurgery","first-page":"S53","article-title":"The supratentorial arteries","volume":"51","author":"Rhoton AL Jr","year":"2002","unstructured":"Rhoton AL JrThe supratentorial arteries. Neurosurgery. 2002;51(4 Suppl):S53\u2013120."},{"key":"b10","first-page":"62","article-title":"Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms","volume":"137","author":"Kim SY","year":"2015","unstructured":"Kim SY, Jeon HJ, Ihm EH, Park KY, Lee JW, Huh SKMicrosurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms. Clin Neurol Neurosurg.2015;137:62\u201366."},{"issue":"5","key":"b11","series-title":"Clinical article. Neurosurg Focus","first-page":"E7","article-title":"Fenestrated aneurysm clips in the surgical management of anterior communicating artery aneurysms: operative techniques and strategy","volume":"26","author":"Zada G","year":"2009","unstructured":"Zada G, Christian E, Liu CY, Giannotta SLFenestrated aneurysm clips in the surgical management of anterior communicating artery aneurysms: operative techniques and strategy. Clinical article. Neurosurg Focus. 2009;26(5):E7."},{"issue":"9","key":"b12","series-title":"Cureus","first-page":"e45863","article-title":"A right-sided approach to anterior communicating artery aneurysms: a case review and technical report","volume":"15","author":"Brazdzionis J","year":"2023","unstructured":"Brazdzionis J, Siddiqi I, Patchana T,  A right-sided approach to anterior communicating artery aneurysms: a case review and technical report. Cureus. 2023;15(9):e45863."},{"issue":"1","key":"b13","series-title":"Chin J Traumatol","first-page":"20","article-title":"Factors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach","volume":"23","author":"Bhattarai R","year":"2020","unstructured":"Bhattarai R, Liang CF, Chen C, Wang H, Huang TC, Guo YFactors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach. Chin J Traumatol. 2020;23(1):20\u201324."},{"issue":"2","key":"b14","series-title":"Article in Japanese. No Shinkei Geka","first-page":"149","article-title":"Clipping of upward projecting anterior communicating aneurysms via pterional craniotomy: approach from the side of A2 of anterior displacement","volume":"34","author":"Hino A","year":"2006","unstructured":"Hino A, Fuse I, Echigo T, Oka H, Iwamoto Y, Fujamoto MClipping of upward projecting anterior communicating aneurysms via pterional craniotomy: approach from the side of A2 of anterior displacement. Article in Japanese. No Shinkei Geka. 2006;34(2):149\u2013158."},{"issue":"2","key":"b15","series-title":"Int J Clin Exp Med","first-page":"1912","article-title":"Effect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: reportof 15 patients","volume":"8","author":"Peng L","year":"2015","unstructured":"Peng L, Li P, Ma AX, Ming L. YEffect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: reportof 15 patients. Int J Clin Exp Med. 2015;8(2):1912\u20131917."},{"issue":"5","key":"b16","series-title":"Pol Przegl Chir","first-page":"1","article-title":"Factors determining best surgical exposure and safe clip positioning in anterior communicating artery (AComA) aneurysms surgery \u2013 particular significance of AComA complex rotation in axial plane","volume":"91","author":"\u015awi\u0105tnicki W","year":"2019","unstructured":"\u015awi\u0105tnicki W, Radomiak-Za\u0142uska A, Heleniak M, Komu\u0144ski PFactors determining best surgical exposure and safe clip positioning in anterior communicating artery (AComA) aneurysms surgery \u2013 particular significance of AComA complex rotation in axial plane. Pol Przegl Chir. 2019;91(5):1\u20135."},{"issue":"1","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"31","article-title":"Side selection of pterional approach for anterior communicating artery aneurysms \u2013 surgical anatomy and strategy","volume":"150","author":"Suzuki M","year":"2008","unstructured":"Suzuki M, Fujisawa H, Ishihara H, Yoneda H, Kato S, Ogawa ASide selection of pterional approach for anterior communicating artery aneurysms \u2013 surgical anatomy and strategy. Acta Neurochir (Wien). 2008;150(1):31\u201339."},{"issue":"5","key":"b18","series-title":"J Clin Neurosci","first-page":"592","article-title":"Side selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms","volume":"17","author":"Hyun SJ","year":"2010","unstructured":"Hyun SJ, Hong SC, Kim JSSide selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms. J Clin Neurosci. 2010;17(5):592\u2013596."},{"issue":"8","key":"b19","series-title":"Acta Neurochir (Wien)","first-page":"925","article-title":"Role of aneurysm projection in \"A2\" fork orientation for determining the side of surgical approach","volume":"151","author":"Chen L","year":"2009","unstructured":"Chen L, Agrawal A, Kato Y,  Role of aneurysm projection in \"A2\" fork orientation for determining the side of surgical approach. Acta Neurochir (Wien). 2009;151(8):925\u2013933."},{"key":"b20","first-page":"e896","article-title":"Anterior communicating artery complex aneurysms: anatomic characteristics as predictors of surgical outcome in 300 cases","volume":"122","author":"Bohnstedt BN","year":"2019","unstructured":"Bohnstedt BN, Conger AR, Edwards J,  Anterior communicating artery complex aneurysms: anatomic characteristics as predictors of surgical outcome in 300 cases. World Neurosurg.2019;122:e896\u2013e906."},{"issue":"4 Suppl","key":"b21","series-title":"Neurosurgery","first-page":"S121","article-title":"Aneurysms","volume":"51","author":"Rhoton AL","year":"2002","unstructured":"Rhoton ALAneurysms. Neurosurgery. 2002;51(4 Suppl):S121\u2013S158."},{"issue":"11","key":"b1","series-title":"Stroke","first-page":"3018","article-title":"Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms","volume":"44","author":"Bijlenga P","year":"2013","unstructured":"Bijlenga P, Ebeling C, Jaegersberg M,  Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms. Stroke. 2013;44(11):3018\u20133026."},{"issue":"26","key":"b2","series-title":"N Engl J Med","first-page":"2474","article-title":"The natural course of unruptured cerebral aneurysms in a Japanese cohort","volume":"366","author":"Morita A","year":"2012","unstructured":"Morita A, Kirino T, Hashi K,  The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474\u20132482."},{"key":"b3","series-title":"Microneurosurgery. Vol II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results","article-title":"Anterior cerebral and anterior communicating artery aneurysms","author":"Ya\u015fargil MG","year":"1984","unstructured":"Ya\u015fargil MGAnterior cerebral and anterior communicating artery aneurysms. In: Ya\u015fargil MG, ed Microneurosurgery. Vol II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. Thieme;1984."},{"issue":"5 Suppl 2","key":"b4","series-title":"Neurosurgery","first-page":"273","article-title":"Microsurgical management of anterior communicating artery aneurysms","volume":"61","author":"Sekhar LN","year":"2007","unstructured":"Sekhar LN, Natarajan SK, Britz GW, Ghodke BMicrosurgical management of anterior communicating artery aneurysms. Neurosurgery. 2007;61(5 Suppl 2):273\u2013292."},{"issue":"1","key":"b5","series-title":"Surg Neurol","first-page":"8","article-title":"Microneurosurgical management of anterior communicating artery aneurysms","volume":"70","author":"Hernesniemi J","year":"2008","unstructured":"Hernesniemi J, Dashti R, Lehecka M,  Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol. 2008;70(1):8\u201328."},{"issue":"4","key":"b6","series-title":"Neurol Res","first-page":"273","article-title":"Surgical approaches to the anterior communicating artery aneurysm and their results","volume":"15","author":"Diraz A","year":"1993","unstructured":"Diraz A, Kobayashi S, Toriyama T, Ohsawa M, Hokama M, Kitazama KSurgical approaches to the anterior communicating artery aneurysm and their results. Neurol Res. 1993;15(4):273\u2013280."},{"key":"b7","series-title":"Front Neurol","first-page":"1020","article-title":"Anterior communicating artery aneurysms: anatomical considerations and microsurgical strategies","volume":"11","author":"Chen J","year":"2020","unstructured":"Chen J, Li M, Zhu X,  Anterior communicating artery aneurysms: anatomical considerations and microsurgical strategies. Front Neurol. 2020;11:1020."},{"key":"b8","series-title":"Seven Aneurysms","article-title":"Anterior communicating artery aneurysms","volume":"94","author":"Lawton MT","year":"2011","unstructured":"Lawton MTAnterior communicating artery aneurysms. In: Lawton MT, ed. Seven Aneurysms. Georg Thieme Verlag;2011:94."},{"issue":"4 Suppl","key":"b9","series-title":"Neurosurgery","first-page":"S53","article-title":"The supratentorial arteries","volume":"51","author":"Rhoton AL Jr","year":"2002","unstructured":"Rhoton AL JrThe supratentorial arteries. Neurosurgery. 2002;51(4 Suppl):S53\u2013120."},{"key":"b10","first-page":"62","article-title":"Microsurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms","volume":"137","author":"Kim SY","year":"2015","unstructured":"Kim SY, Jeon HJ, Ihm EH, Park KY, Lee JW, Huh SKMicrosurgical efficacy and safety of a right-hemispheric approach for unruptured anterior communicating artery aneurysms. Clin Neurol Neurosurg.2015;137:62\u201366."},{"issue":"5","key":"b11","series-title":"Clinical article. Neurosurg Focus","first-page":"E7","article-title":"Fenestrated aneurysm clips in the surgical management of anterior communicating artery aneurysms: operative techniques and strategy","volume":"26","author":"Zada G","year":"2009","unstructured":"Zada G, Christian E, Liu CY, Giannotta SLFenestrated aneurysm clips in the surgical management of anterior communicating artery aneurysms: operative techniques and strategy. Clinical article. Neurosurg Focus. 2009;26(5):E7."},{"issue":"9","key":"b12","series-title":"Cureus","first-page":"e45863","article-title":"A right-sided approach to anterior communicating artery aneurysms: a case review and technical report","volume":"15","author":"Brazdzionis J","year":"2023","unstructured":"Brazdzionis J, Siddiqi I, Patchana T,  A right-sided approach to anterior communicating artery aneurysms: a case review and technical report. Cureus. 2023;15(9):e45863."},{"issue":"1","key":"b13","series-title":"Chin J Traumatol","first-page":"20","article-title":"Factors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach","volume":"23","author":"Bhattarai R","year":"2020","unstructured":"Bhattarai R, Liang CF, Chen C, Wang H, Huang TC, Guo YFactors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach. Chin J Traumatol. 2020;23(1):20\u201324."},{"issue":"2","key":"b14","series-title":"Article in Japanese. No Shinkei Geka","first-page":"149","article-title":"Clipping of upward projecting anterior communicating aneurysms via pterional craniotomy: approach from the side of A2 of anterior displacement","volume":"34","author":"Hino A","year":"2006","unstructured":"Hino A, Fuse I, Echigo T, Oka H, Iwamoto Y, Fujamoto MClipping of upward projecting anterior communicating aneurysms via pterional craniotomy: approach from the side of A2 of anterior displacement. Article in Japanese. No Shinkei Geka. 2006;34(2):149\u2013158."},{"issue":"2","key":"b15","series-title":"Int J Clin Exp Med","first-page":"1912","article-title":"Effect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: reportof 15 patients","volume":"8","author":"Peng L","year":"2015","unstructured":"Peng L, Li P, Ma AX, Ming L. YEffect of clipping anterior communicating artery aneurysms via pterional approach contralateral to supply of dominant blood: reportof 15 patients. Int J Clin Exp Med. 2015;8(2):1912\u20131917."},{"issue":"5","key":"b16","series-title":"Pol Przegl Chir","first-page":"1","article-title":"Factors determining best surgical exposure and safe clip positioning in anterior communicating artery (AComA) aneurysms surgery \u2013 particular significance of AComA complex rotation in axial plane","volume":"91","author":"\u015awi\u0105tnicki W","year":"2019","unstructured":"\u015awi\u0105tnicki W, Radomiak-Za\u0142uska A, Heleniak M, Komu\u0144ski PFactors determining best surgical exposure and safe clip positioning in anterior communicating artery (AComA) aneurysms surgery \u2013 particular significance of AComA complex rotation in axial plane. Pol Przegl Chir. 2019;91(5):1\u20135."},{"issue":"1","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"31","article-title":"Side selection of pterional approach for anterior communicating artery aneurysms \u2013 surgical anatomy and strategy","volume":"150","author":"Suzuki M","year":"2008","unstructured":"Suzuki M, Fujisawa H, Ishihara H, Yoneda H, Kato S, Ogawa ASide selection of pterional approach for anterior communicating artery aneurysms \u2013 surgical anatomy and strategy. Acta Neurochir (Wien). 2008;150(1):31\u201339."},{"issue":"5","key":"b18","series-title":"J Clin Neurosci","first-page":"592","article-title":"Side selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms","volume":"17","author":"Hyun SJ","year":"2010","unstructured":"Hyun SJ, Hong SC, Kim JSSide selection of the pterional approach for superiorly projecting anterior communicating artery aneurysms. J Clin Neurosci. 2010;17(5):592\u2013596."},{"issue":"8","key":"b19","series-title":"Acta Neurochir (Wien)","first-page":"925","article-title":"Role of aneurysm projection in \"A2\" fork orientation for determining the side of surgical approach","volume":"151","author":"Chen L","year":"2009","unstructured":"Chen L, Agrawal A, Kato Y,  Role of aneurysm projection in \"A2\" fork orientation for determining the side of surgical approach. Acta Neurochir (Wien). 2009;151(8):925\u2013933."},{"key":"b20","first-page":"e896","article-title":"Anterior communicating artery complex aneurysms: anatomic characteristics as predictors of surgical outcome in 300 cases","volume":"122","author":"Bohnstedt BN","year":"2019","unstructured":"Bohnstedt BN, Conger AR, Edwards J,  Anterior communicating artery complex aneurysms: anatomic characteristics as predictors of surgical outcome in 300 cases. World Neurosurg.2019;122:e896\u2013e906."},{"issue":"4 Suppl","key":"b21","series-title":"Neurosurgery","first-page":"S121","article-title":"Aneurysms","volume":"51","author":"Rhoton AL","year":"2002","unstructured":"Rhoton ALAneurysms. 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