title: Distal anterior cerebral artery aneurysms: treatment and outcome analysis of 501 patients.
abstract: OBJECTIVE
  This study presents the combined experience of two Finnish neurosurgical centers in the treatment of 501 consecutive patients with distal anterior cerebral artery (DACA) aneurysms. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general and to identify factors predicting the outcome.
  
  
  METHODS
  We analyzed the clinical and radiological data of all 501 patients and focused on the 427 patients treated between 1980 and 2005, the era of microsurgery and computed tomographic imaging. No patients were lost to follow-up. We compared treatment and outcome of ruptured DACA aneurysms (n = 277) with all consecutive ruptured aneurysms from the Kuopio Cerebral Aneurysm Database (n = 2243) and used multivariate analysis to identify factors predicting 1-year outcome.
  
  
  RESULTS
  DACA aneurysms accounted for 6% of all intracranial aneurysms. They were smaller (median, 6 versus 8 mm), more frequently associated with multiple aneurysms (35 versus 18%), and presented more often with intracerebral hematomas (53 versus 26%) than ruptured aneurysms in general. Their microsurgical treatment showed the same complication rates (treatment morbidity, 15%; treatment mortality, 0.4%) as for other ruptured aneurysms. At 1 year after subarachnoid hemorrhage, they had similar favorable outcome (Glasgow Coma Scale score >or=4) as other ruptured aneurysms (74 versus 69%), but their mortality rate was lower (13 versus 24%). Factors predicting unfavorable outcome for ruptured DACA aneurysms were advanced age, Hunt and Hess grade greater than or equal to III, rebleeding before treatment, intracerebral hematoma, intraventricular hemorrhage, and severe preoperative hydrocephalus.
  
  
  CONCLUSIONS
  Despite their specific features, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality at 1 year as ruptured aneurysms in general.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. martin.lehecka@hus.fi
authors.forename: Martin
authors.initials: M
authors.lastname: Lehecka
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Seppo
authors.initials: S
authors.lastname: Juvela
authors.forename: Reza
authors.initials: R
authors.lastname: Dashti
authors.forename: Timo
authors.initials: T
authors.lastname: Koivisto
authors.forename: Antti
authors.initials: A
authors.lastname: Ronkainen
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
authors.forename: Juha A
authors.initials: JA
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality