Background: Distal anterior cerebral artery (DACA) aneurysms are a rare subset of intracranial aneurysms, accounting for 1%–9% of cases. Their deep interhemispheric location, small-caliber vessels and proximity to cortical perforators make surgical management challenging. Microsurgical clipping remains the treatment of choice for ruptured or complex DACA aneurysms. Materials and Methods: We retrospectively analysed 38 patients who underwent microsurgical clipping for DACA aneurysms at our tertiary neurosurgical center between January 2008 and December 2022. Data collected included demographics, comorbidities, clinical presentation (Hunt–Hess and world federation of neurosurgical societies (WFNS) grades), aneurysm morphology, operative details, post-operative complications and functional outcomes. Functional recovery was assessed using the Glasgow Outcome Scale and modified Rankin Scale (mRS) at discharge and follow-up. Results: The cohort included 23 males (61%) and 15 females (39%), with a mean age of 43.2 ± 13 years (range: 26–68). The common comorbidities were hypertension (42%), smoking/tobacco use (24%), diabetes (16%) and chronic alcoholism (13%). Most patients presented with ruptured aneurysms (89.5%). Aneurysms predominantly involved the A3 segment (55.3%) and were saccular in 89.5% of cases. Temporary proximal clipping was used in 78.9% of patients (mean duration: 114 ± 26 s). Complete aneurysm occlusion was achieved in 97.4% of patients. Intraoperative rupture occurred in 13.2% of patients and 30-day mortality was 2.6%. At a 1-year follow-up, 84.2% of patients had favourable functional outcomes (mRS ≤2). Conclusion: Microsurgical clipping of DACA aneurysms is safe and effective, offering high rates of aneurysm obliteration and good functional recovery. Success depends on meticulous interhemispheric dissection, temporary proximal control and careful preservation of distal perforators.
Joshi et al. (Tue,) studied this question.