DISTAL ANTERIOR CEREBRAL-ARTERY ANEURYSMS - A CLINICAL-SERIES

Thirty patients with distal anterior cerebral artery (DACA) aneurysms were seen at the Royal Adelaide Hospital in the period 1970-1996. Ther e were seven males (23%) and twenty three females (77%) with a mean ag e of 50 years. The average follow up was 5 years. Multiple aneurysms w ere present in seven cases (23%). The mean size of aneurysms was 5 mm. There were two post-traumatic aneurysms and one mycotic aneurysm. Out of the 30 cases, 19 presented with subarachnoid haemorrhage from rupt ured DACA aneurysms. Eight (42%) of them were in good clinical grade ( I or II). Operations were carried out in 25 (83%) patients. All five c ases with unruptured aneurysms and the eight patients with good clinic al grade had good recovery. In contrast, only six (55%) out of 11 pati ents with poor clinical grade had good outcome. The overall management mortality for the 19 cases with ruptured aneurysms was 16%. Postopera tive complication occurred in two cases (8%), one patient developed de ep vein thrombosis and seizures, the other patient had transient upper limb weakness. Although there is a definite trend towards better mana gement outcome in the published series of DACA aneurysms over the year s, there is still significant mortality and morbidity in the poor grad e patients. Early surgery will prevent the deaths from rebleeding and may allow optimal management of vasospasm.