[Surgery of the ruptured distal anterior cerebral artery aneurysms]

Distal anterior cerebral artery aneurysms (DACAA) are the particular group of the aneurysms of anterior circle of Willis. The characteristic factors are: different location on the distal anterior cerebral artery, specific surgical approach and rare occurrence.

Retrospective analysis of the outcome and attempt to find risk factors in DACAA surgical treatment were goals of this report.

The authors report a series of 49 cases with DACAA who were operated on in the Department of Neurosurgery, Jagiellonian University in Kraków, in the period of 16 years. There were 29 women (59.2%) and 20 men (40.8%) with a mean age of 49 years. Multiple aneurysm were in 12 cases (24.5%), in which ruptured DACAA were always the cause of the haemorrhage. We investigated age, sex, Hunt and Hess grade, arterial hypertension, timing of operation, coexistence of intracerebral haematoma (ICH), intraventricular haemorrhage (IVH), cerebral ischaemia, hydrocephalus, multiple aneurysms, intraoperative aneurysmal rupture, use of temporary parent vessel clipping, significant brain oedema during surgery, anatomical variability of anterior cerebral artery as a potential risk factors.

There were 29 patients (59.2%) in good and very good clinical state and 11 (22.4%) in poor clinical state on discharge. Nine (18.4%) patients died. Statistically significant factors such as age (p<0.035), arterial hypertension (p<0.0035), Hunt and Hess grade (p<0.0073), IVH (p<0.0054), cerebral ischaemia (p<0.036) affected the direct outcome of patients.

There are typical risk factors in surgically treated DACAA: age, arterial hypertension, clinical status, intraventricular haemorrhage, cerebral ischemia. Most of treated cases remain in good and very good condition. Haemorrhagic and ischaemic complications were most frequent causes of operating losses in DACAA patients.