Distal anterior cerebral artery aneurysms: a clinical series.

Thirty patients with distal anterior cerebral artery (DACA) aneurysms were seen at the Royal Adelaide Hospital in the period 1970-1996. There were seven males (23%) and twenty three females (77%) with a mean age of 50 years. The average follow up was 5 years. Multiple aneurysms were present in seven cases (23%). The mean size of aneurysms was 5 mm. There were two post-traumatic aneurysms and one mycotic aneurysm. Out of the 30 cases, 19 presented with subarachnoid haemorrhage from ruptured DACA aneurysms. Eight (42%) of them were in good clinical grade (I or II). Operations were carried out in 25 (83%) patients. All five cases with unruptured aneurysms and the eight patients with good clinical grade had good recovery. In contrast, only six (55%) out of 11 patients with poor clinical grade had good outcome. The overall management mortality for the 19 cases with ruptured aneurysms was 16%. Postoperative complication occurred in two cases (8%), one patient developed deep vein thrombosis and seizures, the other patient had transient upper limb weakness. Although there is a definite trend towards better management outcome in the published series of DACA aneurysms over the years, there is still significant mortality and morbidity in the poor grade patients. Early surgery will prevent the deaths from rebleeding and may allow optimal management of vasospasm.