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Distal anterior cerebral artery aneurysms.
A A de Sousa1, F L Dantas, G T de Cardoso
1Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Santa Casa de Belo Horizonte, Brazil.
Surgical Neurology
|August 14, 1999
Summary
Distal anterior cerebral artery (DACA) aneurysms are associated with higher risks. A unilateral interhemispheric approach is recommended for treating these fragile, often multiple, intracranial aneurysms.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Cerebrovascular Surgery
Background:
- Distal anterior cerebral artery (DACA) aneurysms, also known as A2 or pericallosal aneurysms, constitute 1.5–9.0% of intracranial aneurysms.
- These aneurysms frequently occur with other intracranial aneurysms and are prone to premature rupture.
- DACA aneurysms exhibit higher morbidity than their appearance suggests.
Purpose of the Study:
- To report surgical outcomes for DACA aneurysms.
- To evaluate different surgical approaches based on aneurysm location.
- To assess the impact of associated aneurysms and surgical strategy on patient outcomes.
Main Methods:
- Retrospective analysis of 72 patients with DACA aneurysms treated between 1982 and 1998.
- Surgical intervention via a unilateral triangular bone flap, with approach tailored to aneurysm location.
- Clipping of all 74 DACA aneurysms, including two giant aneurysms.
Main Results:
- No mortality in patients with single DACA aneurysms; five deaths occurred in patients with multiple aneurysms.
- Good outcomes achieved in 90% of Hunt and Kosnick grades I-II patients and 68.4% of grade III patients.
- Complete clipping of all treated DACA aneurysms was successful.
Conclusions:
- DACA aneurysms present higher morbidity and mortality compared to other supratentorial aneurysms.
- A unilateral interhemispheric approach is recommended for DACA aneurysm treatment.
- Staged surgical procedures are advised for multiple aneurysms, prioritizing ruptured sites, to mitigate mortality risks associated with simultaneous bilateral craniotomies.