Neuronavigation-assisted surgery for distal anterior cerebral artery aneurysm

We present our experience with the neuronavigation system used for surgery of distal anterior cerebral artery (DACA) aneurysms.

Between 2001 and 2004, 12 patients with a DACA aneurysm were consecutively treated with direct clipping assisted by the neuronavigation system. We used the BrainLAB Vector Vision2 neuronavigation system (BrainLAB, Heimstetten, Germany). Seven out of 12 patients presented with subarachnoid hemorrhage. Aneurysms were located at distal A2 in 10 patients and distal A3 in two patients. The size of the aneurysms ranged from 3 to 10 mm.

There were no procedure-related complications or technical problems during application of the neuronavigation system. The registration accuracy ranged from 0.5 to 1.5 mm (mean: 0.88). The neuronavigation system provided real-time presentation of the DACA aneurysm, and allowed for identification of the DACA aneurysm in all patients. No surgical complications developed, and all 12 patients had a good recovery after direct clipping.

Although current neuronavigation systems are not available for all intracranial aneurysms, we believe that the DACA aneurysm is a good candidate for its use. The additional benefits of a small craniotomy and precise intraoperative orientation during surgery result in a minimally invasive aneurysm procedure.