Ruptured Saccular Aneurysms of the Distal Anterior Cerebral Artery : Two Case Reports And A Review of the Literature

Abstract

Distal anterior cerebral artery aneurysms are uncommon and constitute only 1.5-9% of all intracranial aneurysms. They are frequently observed at pericallosal and callosomarginal artery bifurcations. The surgical treatment of distal anterior cerebral artery aneurysms is difficult due to the narrow surgical field of vision and because these aneurysms are accompanied by interhemispheric adhesions and other aneurysms. Two patients with saccular pericallosal and callosomarginal junction aneurysm were surgically treated in our clinic between April 2012 and October 2013. The clinical and radiological findings in both cases were analyzed. A unilateral interhemispheric approach was employed during surgery. Case reports and series reported in the English medical literature were reviewed. The incidence of distal anterior cerebral artery aneurysm at our hospital was 8% of all aneurysms that were subject to surgery (25 cases). Both patients were women. An interhemispheric approach was used in both cases. One patient was discharged with a full recovery and the other patient expired. We propose that the surgical difficulties encountered in distal anterior cerebral artery aneurysm and related complications will be minimized with use of the latest advances in microsurgical techniques and adequate knowledge of the surgical anatomy.

Distal anterior cerebral arter (DACA) anevrizmaları nadirdir ve tüm intrakranial anevrizmaların % 1.5 – 9’unu oluşturur. Sıklıkla pericallosal ve callosomarginal arterlerin bifurcationunda görülür. Dar görüş alanı, interhemisferik yapışıklıklar ve diğer anevrizmalarla birlikte görülmesi nedeniyle DACA anevrizmalı olguların cerrahi tedavisi teknik olarak zordur. Nisan 2012 ile Ekim 2013 arasında 2 adet sacculer PC-CM junction anevrizması kliniğimizde opere edildi. Bu 2 olgunun klinik ve radyolojik bulguları analiz edildi. Operasyonda unilateral interhemiferk yaklaşım uygulandı. İngilizce tıp literatüründeki case reports ve seriler incelendi. Hastanemizdeki DACA anevrizması insidansı cerrahi tedavi uygulanalan tüm anevrizmaların (25 olgu) %8’i idi. Her iki olgu da bayan idi. 2 olgu da interhemisferik yolla opere edildi. 1 olgu tam iyileşme ile taburcu edilirken diğeri öldü. Mikrocerrahi tekniklerin ve cerrahi anatominin yeterince bilinmesi ile DACA anevrizması cerrahisindeki zorlukların ve buna bağlı komplikasyonların en aza indirileceğine inanıyoruz.