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Surgery for distal anterior cerebral artery aneurysms

 Jae Whan Lee  ;  Kyu Chang Lee  ;  Yong Bae Kim  ;  Seung Kon Huh 
 SURGICAL NEUROLOGY , Vol.70(2) : 153-159, 2008 
Journal Title
Issue Date
Anterior Cerebral Artery/diagnostic imaging ; Anterior Cerebral Artery/pathology ; Anterior Cerebral Artery/surgery* ; Cerebral Angiography ; Corpus Callosum/blood supply ; Corpus Callosum/surgery ; Gyrus Cinguli/blood supply ; Gyrus Cinguli/surgery ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/surgery* ; Microsurgery/instrumentation ; Microsurgery/methods* ; Neurosurgical Procedures/instrumentation ; Neurosurgical Procedures/methods* ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; Postoperative Complications/prevention & control ; Preoperative Care/methods ; Subarachnoid Hemorrhage/physiopathology ; Subarachnoid Hemorrhage/prevention & control ; Subarachnoid Hemorrhage/surgery* ; Tomography, X-Ray Computed ; Treatment Outcome
Aneurysm ; Subarachnoid hemorrhage ; Distal anterior cerebral artery ; Microsurgery ; Surgical technique
BACKGROUND: Because DACA aneurysms are located in the narrow interhemispheric space surrounded by the corpus callosum and bilateral cingulate gyri with intervening falx cerebri, they are considered some of the most difficult anterior circulation aneurysms to surgically treat. Moreover, because of their rare occurrence and the emerging nonsurgical treatment options, neurosurgeons are limited in their ability to surgically treat DACA aneurysms due to their lack of experience. This article describes details of the preoperative considerations, operative techniques, and surgical results for DACA aneurysms. METHODS: Medical records, including imaging studies, surgeon's hand drawings and descriptions of microsurgical findings, microphotographs, and video records of operative procedures, were reviewed. RESULTS: Among 3577 patients with intracranial aneurysms treated since 1975, 126 (3.5%) patients with DACA aneurysms were identified. They were treated either by surgery (117 patients) or endovascular treatment (9 patients). The results of surgical treatment for the 117 patients with DACA aneurysms were favorable in 94% (90.6% good and 3.4% fair) and unfavorable in 6% (5.1% poor and 0.9% dead). All unfavorable outcomes occurred in patients who were of preoperative grades 4 or 5. CONCLUSIONS: Successful surgical management of DACA aneurysms depends on precise understanding of their unique microsurgical anatomy, avoidance of pitfalls, and the surgeon's experience. Sufficient brain relaxation, accurate localization of the aneurysm, early identification of the proximal A2 segment, and preservation of the major draining veins are necessary for a safe surgery.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Lee, Kyu Chang(이규창)
Lee, Jae Whan(이재환)
Huh, Seung Kon(허승곤)
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