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KMID : 1005420110130020093
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Journal of Cerebrovascular and Endovascular Neurosurgery
2011 Volume.13 No. 2 p.93 ~ p.101
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Clinical Features of Distal Anterior Cerebral Artery Aneurysm and Treatment Outcomes
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Seo Ju-Sung
Choi Jae-Hyung
Huh Jae-Taeck
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Abstract
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Objective: Distal anterior cerebral artery (DACA) aneurysms are relatively uncommon and surgical management presents some unique technical difficulties. We retrospectively reviewed our experience with 35 DACA aneurysm cases, their clinical features and treatment outcomes to assess the characteristics and treatment outcomes of DACA aneurysms.
Materials and Methods: The medical records of 33 patients with 35 ruptured and unruptured DACA aneurysms were reviewed. Of these, 29 had undergone surgery and four were treated by coil embolization at our institution between September 1992 and January 2010. The clinical presentation, radiologic features and surgical and endovascular treatment outcomes were analyzed.
Results: In our series, the incidence of DACA aneurysms was 35 of 1106 (3.1%) aneurysms. The most common location of these 35 aneurysms was the bifurcation of the pericallosal and callosomarginal arteries (51%). Multiple aneurysms were found in nine patients (27%) and associated vascular anomalies such as azygous anterior cerebral artery and Moyamoya disease were found in six patients (18%). Ninety four percent of the aneurysms were less than 10 mm in diameter. Twenty nine patients were treated by surgical clipping and four patients were treated by coil embolization. Premature rupture of aneurysms and mortality or morbidity directly related to the aneurysmal surgery or endovascular treatments were not observed.
Conclusion: DACA aneurysms have a tendency to rupture before becoming large or giant in size. We achieved favorable outcomes (modified Rankin Scale <4) in 29 of the 33 patients with a tailored surgical approach and coil embolization. Therefore, DACA aneurysms should be treated aggressively even if they are <10 mm in diameter and early surgery can reduce the rate of rebleeding.
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KEYWORD
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Intracranial Aneurysm, Anterior Cerebral Artery
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