Abstract
A 71-year-old woman presented disturbance of consciousness due to subarachnoid hemorrhage (SAH). A computed tomography (CT) on admission revealed diffuse thick SAH and intracerebral hematoma in the right frontal lobe. Conventional angiography and three-dimensional CT angiography showed symmetrical aneurysms located on the bilateral pericallosal arteries at bifurcation of the callosomarginal arteries. The operation was performed on the next day after onset of SAH. The aneurysms were clipped via the right unilateral interhemispheric approach. Intraoperative findings demonstrated a ruptured right-side aneurysm adhered to a left unruptured aneurysm.
Neck clipping was performed with meticulous dissection, especially between both aneurysmal necks. Bilateral distal anterior cerebral artery (BDACA) aneurysms are rarely reported. Surgery of closely located aneurysms requires dissection of all the aneurysmal necks to secure safe and accurate obliteration. Meticulous procedures are nesesary to deal with BDACA similar to kissing aneurysms in the internal carotid artery.
