title: Microsurgical treatment of distal anterior cerebral artery aneurysms: A 25 year institutional experience.
abstract: BACKGROUND
  We present a retrospective study of distal anterior cerebral artery (DACA) aneurysms operated at our institute.
  
  
  METHODS
  From 1988 to 2013, a total of 132 DACA aneurysms were managed surgically. The retrospective data of these patients was collected and analysed.
  
  
  RESULTS
  They comprised 6.2% of all 2137 aneurysms operated during the same period. The mean age at presentation was 48.3 years (range: 24-77 years) and the male: female ratio was 1:2. The notable symptom in 114 (86.4%) patients was headache, in 94 (71.2%) was loss of consciousness, in 25 (18.9%) was seizures, and in 17 (12.9%) was limb weakness. There were 99 (75%) patients in World Federation of Neurosurgical Societies (WFNS) grade <3 at admission. On plain computed tomography (CT) scan, intracerebral hemorrhage was seen in 49 (37.1%) and intraventricular hemorrhage in 23 (17.4%) patients. The most common site of aneurysm was the pericallosal (A3 segment) artery noted in 65 (49.2%) patients. Multiple aneurysms were observed in 16 (12.1%) cases. The mean timing of surgery from the first ictus was 17.8 days. The delay was due to a late referral, poor general condition, recurrent bleeding, and worse WFNS grade at presentation. Aneurysms were operated through the following approaches: parasaggital craniotomy in 61 (46.2%), bifrontal craniotomy in 64 (48.5%), and frontotemporal craniotomy in 7 (5.3%). Aneurysms could be successfully clipped in 93.2% of the cases. Postoperative mortality was 8 (6%). The follow-up data was available for 83 (62.9%) patients. The mean duration of follow-up was 15.1 months (1-70 months), with more than 41 (31%) patients having a follow-up of more than 6 months. A favorable outcome (good recovery or moderate disability) was seen in 71 (85.5%) cases.
  
  
  CONCLUSIONS
  A meticulous attention to the surgical technique provides gratifying results in DACA aneurysms even in patients who present initially in a compromised clinical status.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shukla
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Dhananjaya I
authors.initials: DI
authors.lastname: Bhat
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Dwarkanath
authors.initials: D
authors.lastname: Srinivas
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Sampath
authors.initials: S
authors.lastname: Somanna
authors.affiliation: Department of Neurosurgery, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: Paritosh
authors.initials: P
authors.lastname: Pandey
authors.affiliation: Department of Neurosurgery, Vikram Hospital, Bengaluru, Karnataka, India.
authors.forename: B A
authors.initials: BA
authors.lastname: Chandramouli
authors.affiliation: Department of Neurosurgery, Medwin Hospital, Hyderabad, Telangana, India.
authors.forename: K V R
authors.initials: KV
authors.lastname: Sastry
authors.affiliation: Kalinga Hospital, Bhubaneshwar, Odisha, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Das
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D020771:Anterior Cerebral Artery / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult