Abstract
Distal anterior cerebral artery (DACA) aneurysms are relatively rare, accounting for approximately 1–9% of all intracranial aneurysms. We analyzed the data on 116 DACA aneurysms (55 ruptured and 61 unruptured) that were surgically treated between 2003 and 2023, to evaluate their clinical characteristics and surgical outcomes. A total of 112 operations were performed on 112 patients, with a male-to-female ratio of 1:3 and a mean age of 64.3 years. The most common location was the A2–3 junction (87.1%), with a mean size of 5.6 mm. Multiple aneurysms were present in 34.8% of patients, and azygos anterior cerebral artery was observed in 17.0%. Of the unruptured aneurysms, 41.0% showed enlargement during follow-up. Intracerebral hematoma occurred in 41.8% of the patients with ruptured aneurysms, with the patients with World Federation of Neurosurgical Societies (WFNS) grades 1–2 accounting for 63.6% of this population. The surgical approach emphasized the preservation of bridging veins using an interhemispheric approach and achieved complete mobilization of the aneurysm complex. In 14 patients (12.5%) with falx adhesions, careful dissection was critical to achieve adequate mobilization. Surgical outcomes were excellent in patients with unruptured aneurysms. Overall, 69.1% of the patients with ruptured aneurysms achieved favorable outcomes (modified Rankin Scale score: 0–2), with this rate being 94.3% for patients with WFNS grades 1–2 versus 25.0% for patients with WFNS grades 4–5; this demonstrated that the preoperative grade significantly influenced the outcomes. Despite their small size, DACA aneurysms have a high risk of rupture and require meticulous surgical techniques because of their fragile parent vessels. Excellent results can be achieved at this challenging anatomical location with an appropriate surgical strategy.
