Abstract
Background
Aneurysms of the distal anterior cerebral artery (DACA) are rare but challenging. Even though it is known that aneurysm location on the DACA territory has treatment considerations, the literature is unclear about its clinical and prognostic role.
Material and methods
Our surgical experience over the last 5 years were reviewed to compare the clinical, operative, and outcome characteristics between aneurysms located below the mid portion of the genu of the corpus callosum (called proximal aneurysms) to those distal to this point (called distal aneurysms). A prognostic factor analysis was done using uni and multivariate analysis.
Results
A total of 34 patients were treated (M:F = 1:2.3). The distal group significantly showed poor clinical grade at presentation (n = 9, 47.4%) in contrast to (n = 2, 13.3%) proximal aneurysms (p = 0.039). Despite an overall tendency for a delayed functional improvement in these patients, the results were mainly due to favorable outcomes in the proximal group (favourable functional outcomes at discharge and at last follow-up being 80% and 86.7% respectively). On multivariate analysis, only WFNS grade (> 2) at presentation (OR = 13.75; 95CI = 1.2–157.7) (p = 0.035) and application of temporary clips (AOR = 34.32; 95CI = 2.59–454.1) (p = 0.007), both of which were more in the distal group, independently predicted a poor long term functional outcome.
Conclusion
Aneurysm location impacts preoperative clinical grade and affects intraoperative aneurysm rupture risk rate as well as temporary clipping requirement. The combination of these leads to worse short and long-term functional outcomes in distal DACA aneurysms.