Authors : Rajeev M. P., Pavitharan V. M., Premkumar Sasi, Pravin Yashwant Waykule, Ambresh A K
DOI : 10.18231/2455-8451.2018.0016
Volume : 4
Issue : 2
Year : 0
Page No : 59-63
Introduction: The incidence of DACA aneurysms is between 1.5 to 9.0% of all intracranial aneurysms in the literature. Many of these are <5 mm in diameter. In this case series we report 30 cases of DACA aneurysms between 2009-2016, their presentations, associations and management including the use of neuronavigation system.
Materials and Methods: Among 375 patients with cerebral aneurysms admitted between 2009-2016, 30 patients (8%) had DACA aneurysms, which were studied retrospectively. We analyse the specific clinical and radiological features, surgical strategies and associated anomalies with these DACA aneurysms.
Results: Among the 30 patients with DACA aneurysms, 23 patients (76%) presented with subarachnoid hemorrhage, 7 patients (23%) had intracerebral hematoma, 1 had associated intraventricular haemorrhage and 1 patient had a thrombosed DACA aneurysm. 19 patients had Hunt & Hess grade 1, 8 had grade 2, 1 patient had grade 3 and 2 had grade 4. 23 of the DACA aneurysms (76%) were <5 mm in diameter, 6 were 5-15mm size and 1 had a giant aneurysm (>25mm). 2 patients died preoperatively due to recurrent bleeding. Out of the 28 patients operated, interhemispheric approach was used in 26 patients (92.85%), while pterional approach was used in 2 patients (7.14%). Neuronavigation was used in 16 cases. Postoperative complications included hemiparesis in 2 and death of 1 patient.
Conclusion: The special neurovascular features, location of aneurysm and frequent association with anterior cerebral artery anomalies and other aneurysms must be taken into account when planning occlusive treatment of DACA aneurysms. Neuronavigation is helpful in planning craniotomy and precise localization.
Keywords: DACA aneurysm, Subarachnoid hemorrhage, Neuronavigation.