Surgical experience of the ruptured distal anterior cerebral artery aneurysms

Abstract

Objective: Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of DACA aneurysms, we reviewed our surgical strategy and its results postoperatively.

Methods: A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January 1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe. Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation.

Results: Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate disability, while 2 patients died.

Conclusion: With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm.

Keywords: Aneurysm; Distal anterior cerebral artery; Interhemispheric approach; Neuro-navigating system; Subarachnoid hemorrhage.

Fig. 1

The picture demonstrating how to decide upon a craniotomy site in order to gain a safe surgical corridor in patient with distal anterior cerebral artery aneurysm using a neuro-navigating system.

Fig. 2

Schematic representation of the location of a distal anterior cerebral artery aneurysm in 20 patients. A : Aneurysm located at the origin of the frontobasal artery. B : Aneurysms located at the origin of callosomarginal artery (supracallosal type). C : Aneurysms located at the origin of callosomarginal artery (infracallosal type).