Introduction: Surgical approaches to the frontal basal region as those applied to the anterior communicating artery (AntCommA) aneurysms can lead to post-operative deficits such as memory impairment, executive function disturbances and personality changes1-4. Some of such disturbances may be caused by an aneurysm rupture itself followed by vasospasm or direct injury to the brain parenquima3,4. This is especially true when we consider that many AnCommA aneurysm surgery cases are performed with a variable coagulation degree followed by the gyrus rectus aspiration (GR) in order to provide an appropriate exposure to the vessels. The knowledge concerning the pathways around the gyrus rectus is important to avoid destroying some fiber tracts with its inherent post-operative disturbances.

Methods: Twenty-four adult brains were examined under magnification ranging from 6x to 40x. The surface in all fresh brains and the white matter fiber tract dissections in the frozen specimens, the measurements among the gyrus rectus and those related structures were carried out. Twelve specimens were filled with colored latex to allow a careful study of its arterial and venous relationship with the gyrus rectus.

Results: The results were divided into five parts: osseus, nervous, gyrus rectus anatomy, arterial and venous vasculature in order to provide additional information regarding the vascularization in this area; each relationship with the neighborhood structures was described.

Conclusions: In conclusion, the differentiation between the AnCommA aneurysm primary lesion after bleeding, vasospasm or isquemic related problems and the lesions caused by the surgical treatment itself are very difficult to be accomplished. However, it must be emphasized in this context that a damage to the ventral circuits can be avoided after the anatomical knowledge of this region. The neurosurgeon must search for a detailed 3D view anatomical knowledge of the brain and its relations with the neighborhood structures to offer the best possible treatment.

Patient Care: the close relation of the Gyrus Rectus to the paraolfactory area, the nucleus accumbens septi and the diagonal band of Broca made this zone extremely delicate during the AnCommA dissection procedures. The knowledge concerning the pathways around the gyrus rectus is important to avoid destroying some fiber tracts with its inherent post-operative disturbances.

Learning Objectives: The relation of the Gyrus Rectus with the areas implicated with The cognitive impairment during Acoa Aneurysm dissection.

References: 1. Botter S, Prosiegel M, Steiger H, Yassouridis A. Neurobehavioural disturbances, rehabilitation outcome, and lesion site in patients after rupture and repair of anterior communicating artery aneurysms. J Neurol Neurosurg Psychiatry 1998;65:93-102. [ Links ] 2. Diamond B, Deluca J, Kelley S. Memory and executive functions in amnesic and non-amnesic patients with aneurysms of the anterior communicating artery. Brain 1997;120:1015-1025. [ Links ] 3. Hillis A, Anderson N, Sampath P, Rigamonti D. Cognitive impairments after surgical repair of rupture and unrupture aneurysms. J Neurol Neurosurg Psychiatry 2000;69:608-615. [ Links ] 4. Hitter BO, Gilsbach JM. Cognitive deficits after rupture and early repair of anterior communicating artery aneurysms. Acta Neurochirur (Wien) 1992;116:6-13. [ Links ] 5. Rhoton Al Jr. The cerebrum. Neurosurgery 2002;51(Suppl):S1-S51. [ Links ] 6. Rhoton Al Jr. The supratentorial arteries. Neurosurgery 2002;51(Suppl 1):S53-S120. [ Links ] 7. Rhoton Al Jr. The cerebral veins. Neurosurgery 2002;51(Suppl 1):S159-S205. [ Links ] 8. Rhoton Al Jr. Aneurysms. Neurosurgery 2002;51(Suppl 1):S121-S158. [ Links ] 9. Ebeling U, Cramon D. Topography of the uncinate fascicle and adjacent temporal fibers tracts. Acta Neurochirur (Wien) 1992;115:143-148. [ Links ] 10. Krisht AF. Anterior communicating artery aneurysms: techniques in surgical clipping. Contemp Neurosurg 2001;23:15.1-6. [ Links ]