title: Microneurosurgical management of proximal anterior cerebral artery aneurysms.
abstract: BACKGROUND
  Aneurysms originating from the proximal segment of anterior cerebral artery (A1As) are rare, forming less than 1% of all IAs. There are only few reports on microneurosurgical management of A1As. In this article, the authors review the practical anatomy, preoperative planning, and avoidance of complications in the microsurgical dissection and clipping of A1As.
  
  
  METHODS
  This review, and the whole series on IAs, is mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve without patient selection the catchment area in Southern and Eastern Finland.
  
  
  RESULTS
  These 2 centers have treated more than 10,000 patients with aneurysm since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 aneurysms, there were 23 patients carrying 23 A1As, forming 0.8% of all patients with aneurysm, 0.5% of all aneurysms, and 2% of all ACA aneurysms. Twelve (52%) patients presented with ruptured A1As with ICH in 3 (25%) and IVH in 2 (17%). Seventy percent of patients had at least 1 associated aneurysm.
  
  
  CONCLUSIONS
  Aneurysms arising from A1 are usually small, with a fragile wall. Our data suggest that A1As rupture at smaller size than IAs in general. Because of their small size and involvement of perforating arteries at their base, microneurosurgical clipping is the method of choice in treatment of ruptured A1As. Unruptured A1As also need microneurosurgical clipping even when they are small.
authors: Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
authors: Reza
authors: R
authors: Dashti
authors: Juha
authors: J
authors: Hernesniemi
authors: Hanna
authors: H
authors: Lehto
authors: Mika
authors: M
authors: Niemelä
authors: Martin
authors: M
authors: Lehecka
authors: Jaakko
authors: J
authors: Rinne
authors: Matti
authors: M
authors: Porras
authors: Antti
authors: A
authors: Ronkainen
authors: Surachest
authors: S
authors: Phornsuwannapha
authors: Timo
authors: T
authors: Koivisto
authors: Juha E
authors: JE
authors: Jääskeläinen
mesh_terms: D000758:Anesthesia; D020771:Anterior Cerebral Artery / Q000473:pathology* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D016208:Databases, Factual; D005387:Finland; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D019635:Neurosurgical Procedures / Q000379:methods*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care