Surgery for distal anterior cerebral artery aneurysms.
BACKGROUND
Because DACA aneurysms are located in the narrow interhemispheric space surrounded by the corpus callosum and bilateral cingulate gyri with intervening falx cerebri, they are considered some of the most difficult anterior circulation aneurysms to surgically treat. Moreover, because of their rare occurrence and the emerging nonsurgical treatment options, neurosurgeons are limited in their ability to surgically treat DACA aneurysms due to their lack of experience. This article describes details of the preoperative considerations, operative techniques, and surgical results for DACA aneurysms.


METHODS
Medical records, including imaging studies, surgeon's hand drawings and descriptions of microsurgical findings, microphotographs, and video records of operative procedures, were reviewed.


RESULTS
Among 3577 patients with intracranial aneurysms treated since 1975, 126 (3.5%) patients with DACA aneurysms were identified. They were treated either by surgery (117 patients) or endovascular treatment (9 patients). The results of surgical treatment for the 117 patients with DACA aneurysms were favorable in 94% (90.6% good and 3.4% fair) and unfavorable in 6% (5.1% poor and 0.9% dead). All unfavorable outcomes occurred in patients who were of preoperative grades 4 or 5.


CONCLUSIONS
Successful surgical management of DACA aneurysms depends on precise understanding of their unique microsurgical anatomy, avoidance of pitfalls, and the surgeon's experience. Sufficient brain relaxation, accurate localization of the aneurysm, early identification of the proximal A2 segment, and preservation of the major draining veins are necessary for a safe surgery.
Lee
Jae Whan
JW
Department of Neurosurgery, Yonsei University College of Medicine, Seoul 120752, Korea.
Lee
Kyu Chang
KC
Kim
Yong Bae
YB
Huh
Seung Kon
SK
D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D003337:Corpus Callosum / Q000098:blood supply / Q000601:surgery; D006179:Gyrus Cinguli / Q000098:blood supply / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome