To explore the clinical effect of microsurgical clipping via supraorbital keyhole approach of non-dominant feeder for ruptured anterior communicating artery aneurysms.

The clinical data of 69 patients with ruptured anterior communicating artery aneurysm who underwent microsurgery with supprorbital keyhole approach in the Second Affiliated Hospital of Soochow University from January 2016 to October 2020 were retrospectively analyzed. Among them, 32 patients underwent non-dominant feeder approach and 37 patients underwent dominant feeder approach. The operation duration, the rate of intraoperative aneurysm rupture, the number of intraoperative aneurysm clips, the resection rate of frontal gyrus, the rate of incomplete aneurysm clipping, the variation and torsion rates of anterior communicating artery aneurysm complex, and the good prognosis rate were compared between the two groups.

The operative time of the non-dominant feeder approach group and the dominant feeder approach group was (190±61) min and (204±55) min, respectively. Intraoperative aneurysm rupture occurred in 9 cases (24.3%) and 4 cases (12.5%) in the two groups, respectively. The number of intraoperative aneurysm clips were (1.38±0.61) and (1.35±0.63), the resection rate of frontal gyrus were 37.5% (12/32) and 48.6% (18/37), the rate of aneurysm occlusion was 3.1% (1/32) and 2.7% (1/37), and the variation and torsion rates of anterior communicating artery aneurysm complex were 16 cases (50.0%) and 14 cases (37.8%), respectively. The good prognosis rate of the two groups at discharge were 25 (78.1%) and 28 (75.7%), respectively, and the good prognosis rate at 1 month, 3 months, 6 months and 12 months after discharge were 25 (78.1%) and 27 (73.0%), respectively, with no statistical significance (all P>0.05).

Microsurgery through the supraorbital keyhole approach on the non-dominant feeder is safe and effective for the treatment of ruptured anterior communicating artery aneurysm.