ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2018
Radiographic and microsurgical characteristics of proximal (A1) segment aneurysms of the anterior cerebral artery.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Microneurosurgical management of aneurysms of the A1 segment of the anterior cerebral artery: Anatomy and surgical technique.Surgical neurology international · 2022Article
- Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions.Acta neurologica Belgica · 2021Review
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Abstract
backgroundProximal A1 segment aneurysms of the anterior cerebral artery (ACA) radiologically resemble internal carotid artery bifurcation (ICBIF) aneurysms because of their anatomical proximity. However, proximal A1 aneurysms exhibit distinguishing features, relative to ICBIF aneurysms. We report our experience of managing proximal A1 aneurysms, then compare them to ICBIF aneurysms.
methodsAmong 2191 aneurysms treated between 2000 and 2016 in a single institution, we retrospectively reviewed 100 cases categorized as ICBIF or A1 aneurysms. We included aneurysms originating from the ICBIF and ACA, proximal to the anterior communicating artery (A1 segment) and divided them into two groups: proximal A1 (n = 32) and ICBIF (n = 50). If any portion of the aneurysm involved the ICBIF, it was classified as ICBIF. Aneurysms wholly located in the A1 segment were classified as proximal A1. Patient factors and angiographic factors were evaluated and compared.
resultsThe proximal A1 group exhibited differences in aneurysm size (p = 0.013), posterior aneurysm direction (p = 0.001), and A1 perforators as incorporating vessels (p = 0.001). The proximal A1 group tended to rupture more frequently when the aneurysm was smaller (p = 0.046). One case of morbidity occurred in the proximal A1 group.
conclusionCompared to ICBIF aneurysms, proximal A1 aneurysms were smaller and directed posteriorly, with incorporating perforators. Because of these characteristics, it may be difficult to perform clipping with 360° view in microsurgical field. Therefore, when planning to treat proximal A1 aneurysms, different treatment strategies may be necessary, relative to those used for ICBIF aneurysms.
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