Surgical management of anterior cerebral XXXX of the proximal (A1) segment.

@entity1 @entity455 @entity439 @entity432 @entity204 @entity438
OBJECTIVE: To report a series of 20 consecutive @entity1 with @entity439 of the proximal segment (A1) of the anterior cerebral artery (ACA. METHODS: The medical records of @entity1 who had undergone surgery for @entity438 at two institutions between January 1, 1989, and February 1, 2009, were reviewed. Mean @entity1 age was 52.15 years (range 39-69 years). All 20 @entity1 underwent direct surgery, with clipping or trapping, via standard pterional craniotomy. RESULTS: The incidence of @entity439 was 0.59%. There were 16 @entity1 and 4 @entity1 , showing a strong predominance of this lesion in @entity1 . Mean @entity439 size was 6.95 mm (range 3-10 mm). Four @entity1 (20%) had @entity439 , and three @entity1 (15%) had associated @entity455 . Among @entity1 whose @entity439 originated from perforating arteries, dissection sacrificed the perforating arteries in two @entity1 , and the perforating arteries occluded postoperatively in three @entity1 . In the @entity1 whose @entity439 did not originate from perforating arteries, no perforating arteries were sacrificed during dissection, and perforating arteries became occluded in two @entity1 postoperatively. There was no statistically significant difference between the two groups of @entity1 regarding the incidence of @entity432 . Clinical outcomes were as follows: good recovery in 15 (75%) @entity1 , moderate disability in 2 (10%) @entity1 , severe disability in 2 (10%) @entity1 , and @entity204 in 1 (5%) @entity1 . CONCLUSIONS: The important consideration in surgery for @entity438 is preservation of the perforating arteries, through cautious dissection around the neck or dome and avoidance of direct clip compression, even after releasing the retracted frontal lobe.
