ANEURYSMS OF THE DISTAL ANTERIOR CEREBRAL-ARTERY - REPORT OF 14 CASESAND A REVIEW OF THE LITERATURE

BACKGROUND Distal anterior cerebral artery aneurysms are rare and comp ose about 4.5% of all intracranial aneurysms. They generally arise at the bifurcation of the pericallosal and callosomarginal arteries. Thei r surgical approach is different from those of other anterior circulat ion aneurysms. These aneurysms present some special difficulties for n eurosurgeons, including narrow exposure in the interhemispheric fissur e, dense adhesions between the cingulate gyri, difficulty in controlli ng the parent artery, and the association of multiple aneurysms and va scular anomalies. METHODS Between January 1975 and May 1996, 14 cases of saccular aneurysms of the distal anterior cerebral artery were oper ated at the University of Hacettepe. The clinical presentations, neuro radiological findings, and operative approaches of these aneurysms wer e analyzed. In addition, the clinical series and isolated case reports in the English literature were also extensively reviewed. RESULTS The incidence of the aneurysms in this location was 2.8% of a total of 49 4 surgically treated cases in our center. Of 14 patients, eight were w omen and six were men. Multiple aneurysms were found in five patients (35%). All patients were operated via the interhemispheric route. Thir teen patients had good outcome and one patient died. CONCLUSIONS We be lieve that all difficulties related to distal anterior cerebral artery aneurysms can be minimized with sufficient knowledge of microsurgery and surgical anatomy, using microtechniques and experience. (C) 1998 b y Elsevier Science Inc.