La arteria cerebral anterior distal es el segmento de la arteria cerebral anterior más allá de la comunicante anterior. Los aneurismas de este territorio representan el 0.35–4.5% de todos los aneurismas intracraneales.

De un total de 524 pacientes con aneurismas intracraneales, operados entre Enero de 1981 y Abril de 2002, hubo 20 pacientes con aneurismas de la arteria cerebral anterior distal. Los aneurismas se clasificaron en infracallosos, de la rodilla del cuerpo calloso, y supracallosos. Se utilizó manejo anestésico especializado, soporte craneal de Sugita y técnicas microneuroquirúrgicas. El abordaje utilizado varió con la localización del saco y la multiplicidad. El seguimiento postoperatorio se desarrolló en Terapia Intensiva. Los pacientes fueron evaluados seis meses después de la intervención quirúrgica.

Trece pacientes (65%) se encontraban entre los 31 y 45 años. Todos fueron intervenidos en grado I o II de la Federación Mundial. El 35% tenía sacos múltiples. Todos los aneurismas tenían 11mm o menos de diámetro mayor. En el segmento de la arteria cerebral anterior, próximo a la rodilla del cuerpo calloso, fue donde se encontraron más sacos aneurismáticos (65%). En 16 pacientes (80%) hubo recuperación postoperatorio completa y no hubo fallecidos.

Los aneurismas de la arteria cerebral anterior distal son infrecuentes y requieren de un manejo especial. Tienen tendencia a la multiplicidad y al sangrado precoz. Son sacos localizados en la línea media, en el espacio interhemisférico, lo que permite utilizar craneotomías pequeñas. Debe evitarse el uso de espátulas cerebrales.

Distal anterior cerebral artery is the portion of the anterior cerebral artery located distal to the anterior communicating artery. Aneurysms of that territory represent 0.35–4.5% of all intracranial aneurysms.

524 patients with intracranial aneurysms were operated on between January 1981 and April 2002. We treated 20 patients with distal anterior cerebral artery aneurysms. They were classified as infracallosa, located at the genu of the corpus callosum and supracallosal. Specialized anesthetic methods, Sugita head holder, and microsurgical techniques were utilized. Approaches were modified regarding aneurysm localization and multiplicity. Patients were evaluated six months after surgery. Glasgow Outcome Scale was applied.

Thirteen patients (65%) were between 31 and 45 years of age. All were operated on at Grade I or II of the World Federation Neurological Surgeon Scale. There were múltiple aneurysms in 35% of the cases. All of the aneurysms were 11mm long or less in diameter. The segment of the distal anterior cerebral artery next to the genu of the corpus callosum was the most commonly involved (65%). 16 (80%) patients made a complete postoperative recovery of. There were not deaths.

Distal anterior, cerebral artery aneurysms were not frequent and they needed special management. Their high tendency to multiplicity and early bleeding were two main characteristics. As they are midline located, they permit to perform small size craniotomy. Cerebral retractors were avoided to reduce postoperative morbidity.