Abstract

PLATAS, Marcelo; SAEZ, Martín  and  LAMBRE, Jorge. Aneurismas de la arteria cerebral anterior distal: Revisión de 17 casos operados. Rev. argent. neurocir. [online]. 2007, vol.21, n.4. ISSN 1850-1532.

Objective. To share our experience with 17 cases of distal anterior cerebral artery (DACA) aneurysms operated between January 1994 and December 2006 ,in three different surgical centers in Buenos Aires. Materials and method. Over a total number of 425 intracranial aneurysms operated upon by the autors during twelve years,4% of cases corresponded to DACA aneurysms. Fifteen of them were located at the pericallosal-callosomarginal (PC-CM) junction (genu corpus callosum),and two were considered as subcallosal ones, located at the frontopolar-pericallosal(FP-PC) junction. We have not recorded cases beyond PC-CM bifurcation. In three patients,other malformations coexisted (MCA aneurism in one, ACoA in other, and frontal AVM in other).In no case the asociated malformation was responsible for the patient's bleeding. Results. Surgery was performed between 3 and 30 days after SAH. All aneurysms were clipped,using a frontal paramedian approach except in two cases (frontopolar aneurysms),in which a frontobasal para median approach was performed. Full recovery was achieved in 10 cases. Moderate and mild motor and psichological sequelae were observed in four patients. Three patients died in the inmediate or late postoperative period,with two cases coresponding to grade III of Hunt and Hess scale,and harboring intracerebral hematomas. Conclusions. DACA aneurysms are uncommon (4% in our series of 425 cases). Surgical difficulties were asociated to a typically narrow surgical field, and the surgeon's finding of the aneurysm dome before completing microsurgical dissection. Mortality in our cases(17.7%) was comparable to most surgical series previously published.

Keywords : DACA anurysms; Microsurgery; Paramedian approach.

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