# Optimizing surgical approaches for anterior communicating artery aneurysms: Development and internal validation of a novel surgical scoring system

## TL;DR

This paper introduces a new scoring system to help surgeons choose the best approach for treating anterior communicating artery aneurysms, reducing complications.

## Contribution

A novel surgical scoring system for ACoA aneurysms is developed and internally validated to guide optimal surgical approaches.

## Key findings

- The scoring system showed a significant correlation between higher scores and lower complication rates.
- A cut-off value of 12.5 points was established for predicting complications and outcomes.
- The system supports personalized surgical planning using objective 3D imaging criteria.

## Abstract

The objective was to provide comprehensive preoperative information on both the aneurysm orientation and the side and method of surgical approach for optimal preoperative information and safe clipping using 3D imaging modalities. This was achieved by making an objective risk assessment on the surgical side/method and evaluating its effectiveness with internal validation.

Radiologic data of 61 ACoA aneurysm patients between 2012 and 2020 were retrospectively analyzed. A scoring system based on five criteria; ACoA aneurysm dome orientation, A1 symmetry/control, perforating artery control, A2 trace orientation, and A2 fork symmetry was developed. The system is designed to align with the most common surgical approaches in ACoA aneurysm surgery. The patients were categorized into three groups based on the scoring results to determine the most appropriate surgical method. Group I was recommended, Group II was less recommended, and Group III was least recommended. Internal validation was performed to assess the system’s effectiveness. Outcomes and complication rates were statistically evaluated.

When the scoring system was utilized, the mean score difference between the first group and the other groups was 2.71 and 4.62, respectively. There was a homogeneous distribution among the groups in terms of age, sex, WFNS, and Fisher scores. Complication occurred in three patients in Group I and nine patients each in Group II and Group III. The further the deviation from the first option, the higher the complication rate (p = 0.016), and a significant cause–effect relationship was identified (p = 0.021). The ROC curve established a cut-off value of 12.5 points for complications and outcomes.

Our study introduces a new scoring system for ACoA aneurysms, enhancing the use of 3D CTA in daily practice and providing internal validation for the proposed approach. By evaluating objective criteria, this scoring system helps predict surgical risks, prevent complications, and supports personalized evaluation and selection of the surgical approach based on objective criteria.