Microneurosurgical management of proximal anterior cerebral artery aneurysms.
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.
Dashti
Reza
R
Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
Hernesniemi
Juha
J
Lehto
Hanna
H
Niemelä
Mika
M
Lehecka
Martin
M
Rinne
Jaakko
J
Porras
Matti
M
Ronkainen
Antti
A
Phornsuwannapha
Surachest
S
Koivisto
Timo
T
Jääskeläinen
Juha E
JE
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