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Radiographic and microsurgical characteristics of proximal (A1) segment aneurysms of the anterior cerebral artery.

 Chang Ki Jang  ;  E-Wook Jang  ;  Kwang-Chun Cho  ;  Sang Hyun Suh  ;  Joonho Chung  ;  Yong Bae Kim  ;  Chang-Ki Hong  ;  Jin-Yang Joo 
 NEUROLOGICAL SCIENCES, Vol.39(10) : 1735-1740, 2018 
Journal Title
Issue Date
Aneurysm ; Anterior cerebral artery ; Intracranial aneurysm
BACKGROUND: Proximal A1 segment aneurysms of the anterior cerebral artery (ACA) radiologically resemble internal carotid artery bifurcation (ICBIF) aneurysms because of their anatomical proximity. However, proximal A1 aneurysms exhibit distinguishing features, relative to ICBIF aneurysms. We report our experience of managing proximal A1 aneurysms, then compare them to ICBIF aneurysms. METHODS: Among 2191 aneurysms treated between 2000 and 2016 in a single institution, we retrospectively reviewed 100 cases categorized as ICBIF or A1 aneurysms. We included aneurysms originating from the ICBIF and ACA, proximal to the anterior communicating artery (A1 segment) and divided them into two groups: proximal A1 (n = 32) and ICBIF (n = 50). If any portion of the aneurysm involved the ICBIF, it was classified as ICBIF. Aneurysms wholly located in the A1 segment were classified as proximal A1. Patient factors and angiographic factors were evaluated and compared. RESULTS: The proximal A1 group exhibited differences in aneurysm size (p = 0.013), posterior aneurysm direction (p = 0.001), and A1 perforators as incorporating vessels (p = 0.001). The proximal A1 group tended to rupture more frequently when the aneurysm was smaller (p = 0.046). One case of morbidity occurred in the proximal A1 group. CONCLUSION: Compared to ICBIF aneurysms, proximal A1 aneurysms were smaller and directed posteriorly, with incorporating perforators. Because of these characteristics, it may be difficult to perform clipping with 360° view in microsurgical field. Therefore, when planning to treat proximal A1 aneurysms, different treatment strategies may be necessary, relative to those used for ICBIF aneurysms.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Chung, Joon Ho(정준호)
Joo, Jin Yang(주진양)
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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