Distal anterior cerebral artery aneurysms(DACA) are rare and regarded as more different type of aneurysm, primarily because of their anatomical peculiarities. The author experienced 11 cases of DACA aneurysms with microsurgical aneurysm heck
clipping
between July, 1991 and July, 1995. The incidence of these aneurysms was 3.8% of 288 aneurysms managed during this period, 7 cases of 11 DACA aneurysms occured at branching point of pericallosal artery at the genu of the corpus callosum and at the
point
of origin of the callosomarginal artery : other 4 cases arised from proximal A2(second segment of ACA). 8 patients had additional vascular anomalies documented by angiogram such as multiple aneurysm, azygos A2 and fenestration of proximal A2.
Most
were
less than 5 mm in diameter but 1 was large(2.1 cm in diameter). Ruptured ACA aneurysms were frequently associated with hematoma or intraventricular hemorrhage.
Direct neck clipping was possible in all cases through the interhemispheric approach via frontal paramedian craniotomy, pterional approach, or combined. The surgical results were good; there were 4 poor outcome or death, all in patient with poor
preoperative neurologic grade.
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