Introduction: Distal anterior cerebral artery is the portion of the anterior cerebral artery located distal to the anterior communicating artery. Aneurysms of that territory represent 0.35 - 4.5% of all intracranial aneurysms.
Material and methods: 524 patients with intracranial aneurysms were operated on between January 1981 and April 2002. We treated 20 patients with distal anterior cerebral artery aneurysms. They were classified as infracallosa, located at the genu of the corpus callosum and supracallosal. Specialized anesthetic methods, Sugita head holder, and microsurgical techniques were utilized. Approaches were modified regarding aneurysm localization and multiplicity. Patients were evaluated six months after surgery. Glasgow Outcome Scale was applied.
Results: Thirteen patients (65%) were between 31 and 45 years of age. All were operated on at Grade I or II of the World Federation Neurological Surgeon Scale. There were multiple aneurysms in 35% of the cases. All of the aneurysms were 11 mm long or less in diameter. The segment of the distal anterior cerebral artery next to the genu of the corpus callosum was the most commonly involved (65%). 16 (80%) patients made a complete postoperative recovery of. There were not deaths.
Conclusion: Distal anterior, cerebral artery aneurysms were not frequent and they needed special management. Their high tendency to multiplicity and early bleeding were two main characteristics. As they are midline located, they permit to perform small size craniotomy. Cerebral retractors were avoided to reduce postoperative morbidity.