title: Distal anterior cerebral artery aneurysms: bifrontal basal anterior interhemispheric approach.
abstract: BACKGROUND
  Distal anterior cerebral artery (DACA) aneurysms are uncommon. Most authors have reported technical difficulties during surgery for these aneurysms, and a variety of surgical approaches have been advocated.
  
  
  METHODS
  Over a period of 5 years (1999-2003), 67 patients with DACA aneurysms were operated. Twenty-eight of these were operated on through the bifrontal basal anterior interhemispheric approach. Of the 28 patients, 68% were in poor clinical grade (Hunt and Hess grade III-V) and 89.3% had a Fisher grade III and IV on computed tomography scan. A surgical trajectory about 2 to 3 cm superior to the anterior cranial fossa floor led directly to the aneurysm. Proximal control was achieved before aneurysm dissection and parallel clipping.
  
  
  RESULTS
  Good outcome (Glasgow Outcome Scale V and IV) was seen in 57.19 of the patients, 14.3% had a poor outcome, and 28.6% died. The cause of death in most patients was found to be a poor clinical grade, postoperative infarct, or presence of multiple aneurysms.
  
  
  CONCLUSIONS
  The advantages of the bifrontal basal anterior interhemispheric approach were the following: (a) It provided the shortest and a direct trajectory to the aneurysm. (b) Proximal control of the parent A(2) vessels could be easily achieved. (c) Release of cerebrospinal fluid from basal cisterns could be done, if necessary. (d) There was a minimal distortion of or traction over the aneurysm.
authors.affiliation: Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chhabra
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Gupta
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mohindra
authors.forename: Kanchan
authors.initials: K
authors.lastname: Mukherjee
authors.forename: Rajeev
authors.initials: R
authors.lastname: Bapuraj
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.forename: Virender K
authors.initials: VK
authors.lastname: Khosla
mesh_terms: D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology; D002540:Cerebral Cortex / Q000098:blood supply* / Q000601:surgery*; D035262:Cranial Fossa, Anterior / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009026:Mortality; D019635:Neurosurgical Procedures / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D012886:Skull / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends