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A I-segment aneurysms: management protocol based on a new classification.

Kamlesh Singh Bhaisora, Sanjay Behari1, Guru Prasadh

  • 1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Neurology India
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Summary
This summary is machine-generated.

Aneurysms in the A1-segment of the anterior cerebral artery (ACA) are rare and present unique challenges. A new classification system helps identify surgical difficulties associated with these specific aneurysms.

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Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Neuroradiology

Background:

  • Aneurysms of the proximal (A1)-segment of the anterior cerebral artery (ACA) are rare, comprising less than 1% of all intracranial aneurysms.
  • These aneurysms present unique management challenges due to their location and anatomical characteristics.

Purpose of the Study:

  • To study the management dilemmas of A1-segment aneurysms.
  • To introduce a novel classification system based on the aneurysm's location on the longitudinal and circumferential axis of the A1-segment.

Main Methods:

  • Retrospective analysis of 14 patients with A1-segment aneurysms treated at a tertiary care referral center.
  • Data included clinical features, imaging findings (CT, CTA/DSA), modified Hunt and Hess (H and H) grade, and surgical details.
  • A new classification system was developed based on aneurysm location (proximal, distal, mid-segment; anterior, posterior-inferior, posterior-superior).

Main Results:

  • The 14 patients had a mean age of 38.02 years, with varying H and H grades (I-V).
  • Common presentations included intraventricular hemorrhage (66%) and intracerebral hematoma (16.66%).
  • Follow-up recovery (mean 2.9 years) correlated with preoperative H and H grade, with mortality in severe cases.

Conclusions:

  • A1-segment aneurysms exhibit distinct features, including small size at rupture, multiplicity, potential for being undetected on initial imaging, and proximity to perforating arteries.
  • The proposed classification system aids in identifying and managing surgical difficulties associated with different A1-aneurysm locations.