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KMID : 1001920070420040281
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Journal of Korean Neurosurgical Society
2007 Volume.42 No. 4 p.281 ~ p.285
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Surgical Experience of the Ruptured Distal Anterior Cerebral Artery Aneurysms
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Lee Jong-Young
Park Se-Hyuck
Oh Sae-Moon
Kim Moon-Kyu
Cho Byung-Moon
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Abstract
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Objective: : Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for
intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of
DACA aneurysms, we reviewed our surgical strategy and its results postoperatively.
Methods: : A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January
1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on
according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of
CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary
clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe.
Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative
radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation.
Results: : Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one
DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed
complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual
neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate
disability, while 2 patients died.
Conclusion: : With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality
rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and
neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm.
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KEYWORD
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Distal anterior cerebral artery, Aneurysm, Subarachnoid hemorrhage, Interhemispheric approach, Neuro-navigating system
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