Clinical Features of Distal Anterior Cerebral Artery Aneurysms Based on 26 Consecutive Cases

Han, Myung Hun; Cheong, Jin Hwan; Kim, Jae Min; Kim, Choong Hyun

Abstract

OBJECTIVE
Distal anterior cerebral artery (DACA) aneurysms are relatively uncommon, and operative management is usually difficult because of narrow operative fields, deep exposure, interhemispheric adhesions, and problems in achieving proximal vessel control. We present our experience with 26 DACA aneurysm cases and analyze the clinical features and surgical outcomes retrospectively.
METHODS
From 1998 to 2008, surgical clipping of DACA aneurysms was carried out in 26 patients among a total of 504 patients with intracranial aneurysms. In each case, the clinical and radiological features were carefully reviewed through angiograms, medical records, and intraoperative findings.
RESULTS
The most common location of DACA aneurysms was the junction of the pericallosal and callosomarginal arteries: 23 occurred at pericallosal-callosomarginal (PC-CM) junctions while three occurred in the pericallosal-frontopolar (PC-FP) region. Multiple aneurysms were found in 15 cases (58%), and associated vascular anomalies were noted in three cases (12%). Eleven (64.7%) of the 17 ruptured aneurysms and seven (77.8%) of the nine unruptured aneurysms were smaller than 7 mm; only two aneurysms (7.7%) were larger than 10 mm. Seven cases (26.9%) underwent minor premature rupture with proximal artery control.
CONCLUSION
Despite the small patient group, our data suggest that in general, DACA aneurysms tend to rupture at a smaller size than do intracranial aneurysms. Thus, unruptured DACA aneurysms require aggressive treatment, even when they are small.