{"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":1780131707851,"version":"3.54.0"},"reference-count":58,"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":"\n OBJECTIVE<\/jats:title>\n Large, giant, and complex anterior communicating artery (ACoA) and A2 anterior cerebral artery (ACA) aneurysms may require a bifrontal interhemispheric approach for better exposure of the aneurysm and bilateral A2-ACA branches and the ability to perform a bypass if needed. The authors sought to investigate the operative techniques and long-term outcomes of ACoA and proximal A2-ACA aneurysms treated with the bifrontal interhemispheric approach.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors reviewed ACoA and proximal A2-ACA aneurysms treated by microsurgical clipping with or without a bypass via the bifrontal interhemispheric approach from 2005 to 2024 as a subset of all ACoA aneurysms surgically treated at their institution. The indications for this approach were 1) a complex neck requiring exposure of bilateral A1 and A2 vessel segments, and\/or 2) need for bypass. Demographic, clinical, and radiographic data were collected and reviewed. Aneurysm occlusion, bypass patency, functional outcomes (modified Rankin Scale [mRS] score), and complications were assessed at the 3-month and long-term (> 12 months) follow-up.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of 383 patients with ACoA or proximal A2-ACA aneurysms treated with microsurgery at the authors\u2019 institution, 30 patients met the inclusion criteria. The mean radiographic follow-up was 3.1 years. Sixty percent of patients (18\/30) had a subarachnoid hemorrhage. Twenty-five (83.3%) aneurysms were ACoA and 5 (16.7%) were proximal A2-ACA. Bypasses were performed for 16 (53%) aneurysms. Direct side-to-side bypasses were the most common, accounting for 81% (13\/16) of all bypasses. Complete aneurysm occlusion was achieved in 90% of aneurysms at the last follow-up. Immediate postoperative patency of the bypass was 100% (16\/16). Long-term bypass patency was 87.5% (7\/8). Postoperative stroke occurred in 2 patients (6.7%), both of whom recovered with mRS scores < 2 at the 3-month follow-up.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The bifrontal interhemispheric approach offers the ability to expose large and giant ACoA aneurysms and bilateral A2 vessel aneurysms, which allows an operative corridor for possible bypass revascularization. The results of this approach were excellent, with a low rate of aneurysm recurrence and complications.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.9.focus25777","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:25:13Z","timestamp":1764595513000},"page":"E7","source":"Crossref","is-referenced-by-count":0,"title":["Microsurgical management of complex anterior communicating artery and proximal A2 anterior cerebral artery aneurysms by the bifrontal interhemispheric approach"],"prefix":"10.3171","volume":"59","author":[{"given":"Malia","family":"McAvoy","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varadaraya S.","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Abecassis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Nistal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie H.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis J.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laligam N.","family":"Sekhar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, and"},{"name":"Department of Radiology, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5 Suppl 2","key":"b1","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 B. Microsurgical management of anterior communicating artery aneurysms. Neurosurgery. 2007;61(5 Suppl 2):273\u2013292."},{"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","year":"2012","unstructured":"The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;366(26):2474\u20132482."},{"issue":"5","key":"b3","series-title":"Neurosurgery","first-page":"1106","article-title":"Current indications, trends, and long-term results of 233 bypasses to treat complex intracranial aneurysms: a location-specific analysis","volume":"95","author":"Sekhar LN","year":"2024","unstructured":"Sekhar LN, Shenoy VS, Sen RD, Current indications, trends, and long-term results of 233 bypasses to treat complex intracranial aneurysms: a location-specific analysis. Neurosurgery. 2024;95(5):1106\u20131116."},{"key":"b4","series-title":"World Neurosurg","first-page":"250","article-title":"Microsurgical treatment of cerebral aneurysms","volume":"159","author":"Rutledge C","year":"2022","unstructured":"Rutledge C, Baranoski JF, Catapano JS, Lawton MT, Spetzler RF. Microsurgical treatment of cerebral aneurysms. World Neurosurg. 2022;159:250\u2013258."},{"key":"b5","series-title":"World Neurosurg","first-page":"e103","article-title":"Microsurgical treatment of cerebral aneurysms after previous endovascular therapy: single-center series and systematic review","volume":"123","author":"Roy AK","year":"2019","unstructured":"Roy AK, Philipp LR, Howard BM, Cawley CM, Grossberg JA, Barrow DL. Microsurgical treatment of cerebral aneurysms after previous endovascular therapy: single-center series and systematic review. World Neurosurg. 2019;123:e103\u2013e115."},{"issue":"3","key":"b6","series-title":"J Neurosurg","first-page":"654","article-title":"Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety","volume":"143","author":"Lee KS","year":"2025","unstructured":"Lee KS, Wroe-Wright O, Zhang JJY, Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety. J Neurosurg. 2025;143(3):654\u2013667."},{"issue":"4","key":"b7","series-title":"Neurosurgery","first-page":"566","article-title":"Treatment of ruptured anterior communicating artery aneurysms: equipoise in the endovascular era?","volume":"77","author":"Moon K","year":"2015","unstructured":"Moon K, Levitt MR, Almefty RO, Treatment of ruptured anterior communicating artery aneurysms: equipoise in the endovascular era? 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Neurosurgery. 1999;44(1):117\u2013117."},{"issue":"4","key":"b16","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"193","article-title":"A new definition for wide-necked cerebral aneurysms","volume":"21","author":"Park HS","year":"2019","unstructured":"Park HS, Kwon SC, Park ES, Park JB, Kim MS. A new definition for wide-necked cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg. 2019;21(4):193\u2013198."},{"issue":"1","key":"b17","series-title":"J Neurosurg","first-page":"159","article-title":"Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications","volume":"133","author":"Hendricks BK","year":"2020","unstructured":"Hendricks BK, Yoon JS, Yaeger K, Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications. 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World Neurosurg. 2023;175:31\u201344."},{"issue":"5","key":"b22","series-title":"Neurosurg Rev","first-page":"3157","article-title":"Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis","volume":"45","author":"Yarahmadi P","year":"2022","unstructured":"Yarahmadi P, Kabiri A, Bavandipour A, Jabbour P, Yousefi O. Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis. Neurosurg Rev. 2022;45(5):3157\u20133170."},{"issue":"1","key":"b23","series-title":"BMC Neurol","first-page":"287","article-title":"Recurrence and retreatment of anterior communicating artery aneurysms after endovascular treatment: a retrospective study","volume":"20","author":"Jang CK","year":"2020","unstructured":"Jang CK, Chung J, Lee JW, Huh SK, Son NH, Park KY. 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J Clin Neurosci. 2024;127:110766."},{"issue":"1","key":"b26","series-title":"Neurosurg Rev","first-page":"366","article-title":"Anterior interhemispheric vs. pterional approach in the microsurgical management of anterior communicating artery aneurysms: a comparative analysis employing a novel multidimensional matching-tool","volume":"47","author":"Swiatek VM","year":"2024","unstructured":"Swiatek VM, Amini A, Spitz L, Anterior interhemispheric vs. pterional approach in the microsurgical management of anterior communicating artery aneurysms: a comparative analysis employing a novel multidimensional matching-tool. 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J Clin Neurosci. 2024;127:110766."},{"issue":"1","key":"b26","series-title":"Neurosurg Rev","first-page":"366","article-title":"Anterior interhemispheric vs. pterional approach in the microsurgical management of anterior communicating artery aneurysms: a comparative analysis employing a novel multidimensional matching-tool","volume":"47","author":"Swiatek VM","year":"2024","unstructured":"Swiatek VM, Amini A, Spitz L, Anterior interhemispheric vs. pterional approach in the microsurgical management of anterior communicating artery aneurysms: a comparative analysis employing a novel multidimensional matching-tool. Neurosurg Rev. 2024;47(1):366."},{"issue":"6","key":"b27","series-title":"Acta Neurochir (Wien)","first-page":"1079","article-title":"Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex\u2014a cadaveric study","volume":"159","author":"Spiessberger A","year":"2017","unstructured":"Spiessberger A, Baumann F, Nevzati E, Kothbauer KF, Fandino J, Muroi C. Minimally invasive medial supraorbital, combined subfrontal-interhemispheric approach to the anterior communicating artery complex\u2014a cadaveric study. Acta Neurochir (Wien). 2017;159(6):1079\u20131085."},{"issue":"2","key":"b28","series-title":"J Neurosurg","first-page":"198","article-title":"The extended frontal approach to tumors of the anterior, middle, and posterior skull base","volume":"76","author":"Sekhar LN","year":"1992","unstructured":"Sekhar LN, Nanda A, Sen CN, Snyderman CN, Janecka IP. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg. 1992;76(2):198\u2013206."},{"issue":"1-4","key":"b29","series-title":"Acta Neurochir (Wien)","first-page":"127","article-title":"Modified bifrontal interhemispheric approach to aneurysms of the anterior communicating artery with the use of a trephine craniotomy - a review of personal experience with 25 cases","volume":"125","author":"Kikuchi K","year":"1993","unstructured":"Kikuchi K, Watanabe K. Modified bifrontal interhemispheric approach to aneurysms of the anterior communicating artery with the use of a trephine craniotomy - a review of personal experience with 25 cases. 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