2017 Volume 45 Issue 2 Pages 95-100
Aneurysms of the A1 segment of the anterior cerebral artery (A1 aneurysms) are rare and challenging to treat. Two important points are related to the surgical treatment of A1 aneurysms. First, saccular A1 aneurysms are often small, but close to vital perforating arteries. The perforators are commonly attached to the aneurysm dome. The second issue relates to the fact that A1 aneurysms often present as dissecting or fusiform aneurysms that usually involve perforators. We reviewed 4 surgically treated cases of A1 aneurysms, of which 3 were ruptured and 1 was unruptured. The operations were performed by one surgeon (J.I.) from April 2009 to April 2015. The cases comprised 2 saccular A1 aneurysms, of which one was a fusiform A1 aneurysm and the other was a dissecting A1 aneurysm. Neck clipping was performed in 2 cases of saccular A1 aneurysms, causing no neurological deficit. The dissecting A1 aneurysm was trapped surgically, resulting in cerebral infarction in the territory of the perforating arteries. Proximal clipping was performed for the fusiform A1 aneurysm. Fusiform A1 and dissecting A1 aneurysms are special subgroups that require tailored surgical strategies because of the high risk of perforators being damaged. We report a series of 4 patients with A1 aneurysm, focusing on the surgical strategies, with a review of the literature.
