Distal anterior cerebral artery aneurysms: bifrontal basal anterior interhemispheric approach.
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.
Chhabra
Rajesh
R
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Gupta
Sunil K
SK
Mohindra
Sandeep
S
Mukherjee
Kanchan
K
Bapuraj
Rajeev
R
Khandelwal
Niranjan
N
Khosla
Virender K
VK
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