Microvascular Clipping of A1 Segment Aneurysms.

Area of Science:

• Neurosurgery
• Vascular Neurology
• Cerebrovascular Diseases

Background:

• Aneurysms of the proximal anterior cerebral artery (A1 segment) are uncommon.
• Their small size, location, and proximity to perforating arteries pose significant surgical challenges.

Purpose of the Study:

• To present the experience with surgical management of A1 segment aneurysms.
• To analyze the clinical features, treatment, and outcomes of these rare aneurysms.

Main Methods:

• Retrospective review of 7 patients with A1 aneurysms treated between 2009 and 2017.
• Preoperative assessment included NCCT and angiography; grading used WFNS, Fisher, and H&H systems.
• All patients underwent microneurosurgical clipping.

Main Results:

• All 7 aneurysms were saccular, ranging from 4-14 mm, with 5 (71.4%) directed posteriorly.
• Anatomical variations were noted in 3 (42.8%) patients.
• Microsurgical clipping resulted in good outcomes (GOS/mRS) in 6 (85.7%) patients; no deaths occurred.

Conclusions:

• A1 aneurysms often present with vascular anomalies and rupture at a small size.
• Posteriorly directed A1 aneurysms and proximity to perforators increase surgical difficulty.
• Despite challenges, microneurosurgical clipping offers favorable outcomes for A1 aneurysms.