Most common site for aSAH
ACOM
ACOM anurysum present with
DI and hypothalamus dysfunction
Location of vasospasm in ACOM
ACA bilateral ➡️ frontal syndrome
Surgical approach ACOM
pterional
Sub frontal of aneurysms pointing ⬆️
anterior interhemispheric approach ( lowest 🧠 retraction) 🚫🚫 if pointing anteriorly
transcallosal approach
Right vs left Pterional in ACOm
Right is usual except 🚨
Large acom pointing to the right : left > right
Dominant feeder from left : left > right
Additional left aneurysm
1 ST CN seen in pterional apprach
Olfactory then optic
Pterional apprach 🚨 Critical artery need to preserve
recurrent artery of Heubner; small ACoA perforators