Clinical features and surgical outcomes of ruptured distal anterior cerebral artery aneurysms in 20 consecutively managed patients.
Optimal surgical management of ruptured aneurysms of the distal anterior cerebral artery continues to provide unique technical challenges. This study presents 20 consecutively managed such patients, with special attention given to the clinical and radiological characteristics, as well as the surgical outcomes. Intracerebral hematoma was seen in 11 of the 20 patients, and intraventricular hemorrhage occurred in 4 (20%). Angiography revealed that 9 (45%) patients had multiple aneurysms. Three patients (15%) had "mirror" distal anterior cerebral arterial aneurysms on the contralateral side. Eleven patients (55%) had aneurysms located at the supracallosal portion of the anterior cerebral artery, while 9 patients (45%) had aneurysms located below the genu of the corpus callosum. The mean aneurysmal diameter was 3.85 mm; 18 aneurysms (90%) were less than 6 mm in diameter. Eighteen patients (90%) underwent a microsurgical procedure; 2 (10%) underwent endovascular coiling due to poor clinical grade. A favorable outcome was achieved in 14 (70%) patients. Advances in microsurgical techniques will be required to further improve clinical outcome.
Otani
Naoki
N
Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo 190-0014, Japan. naotani@tdmc.hosp.go.jp
Takasato
Yoshio
Y
Masaoka
Hiroyuki
H
Hayakawa
Takanori
T
Yoshino
Yoshikazu
Y
Yatsushige
Hiroshi
H
Sumiyoshi
Kyoko
K
Miyawaki
Hiroki
H
Aoyagi
Chikashi
C
Takeuchi
Satoru
S
Suzuki
Go
G
D000368:Aged; D000369:Aged, 80 and over; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D019736:Prostheses and Implants; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
D004234:Diuretics, Osmotic