PurposeThis study is an overview of the clinical and angiographic outcomes of patients who undergo treatment for distal anterior cerebral artery aneurysms.Materials and MethodsBetween January 2009 and March 2012, 444 cerebral aneurysms were treated using endovascular coil embolization at our institute. Among them, 217 aneurysms were followed-up with angiography at least six months later. Of these, there were 16 distal anterior cerebral artery (ACA) aneurysms in 16 patients. We conducted a retrospective review of clinical and radiological follow-up results of all patients with distal ACA aneurysms. The clinical and angiographic outcomes were assessed using the modified Rankin scale (mRS) and the Raymond classification scale, respectively.ResultsThe mean age was 54.7 ± 10.2 years (41-75 years). The mean follow-up period was 20.6 ± 9.64 months (6-37 months). Three patients presented with acute rupture. The average aneurysm size was 4.98 ± 1.39 mm (3.0-8.1 mm), and eight of 16 aneurysms (50%) had aspect ratios < 2.0. All 16 patients presented with complete obliteration immediately after the procedure. However, two patients had procedure-related complications, one with coil extrusion to the subarachnoid space without hemorrhage and one with thromboembolism subsequent to chemical thrombolysis. In the follow-up angiography, one major and five minor recurrences (for a total of six recurrences, 37.5%) were detected. However, the differences between the ACA aneurysm group and others were not statistically significant. Clinical outcomes were good for all of the patients at the time of discharge (mean mRS: 0.25, 0 to 1) and at the follow-ups (mean mRS: 0).ConclusionDespite a comparatively high recurrence rate, the endovascular treatment of distal anterior cerebral aneurysms is feasible and has a good clinical outcome.

We investigated the relationship between the peripapillary retinal nerve fiber layer and peripapillary retinal thickness in patients with diabetic macular edema. Fifty eyes (group I) with non-proliferative diabetic retinopathy and diabetic macular edema receiving intravitreal anti-VEGF injection, and 90 eyes (group II) without diabetic macular edema were included in this case-control study. The peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, and a new retinal nerve fiber layer index using a modeled relationship between the two parameters were evaluated with spectral-domain optical coherence tomography, at baseline and at the 6-month follow-up. In group I, the peripapillary retinal nerve fiber layer thickness decreased from 126.4 μm at baseline to 117.6 μm at 6 months (p < 0.001), while the peripapillary retinal thickness decreased from 376.0 μm at baseline to 359.6 μm at 6 months (p < 0.001) after intravitreal anti-VEGF injection. In group II, however, both the parameters remained stable at the 6-month follow-up (100.7 to 102.1 μm and 311.1 to 316.2 μm, respectively, and all p > 0.01). Analysis with the new index to adjust for retinal edema showed no significant change from baseline to 6 months in both groups (p = 0.593 and p = 0.101, respectively). The peripapillary retinal nerve fiber layer thickness is strongly affected by the peripapillary retinal thickness. Therefore, the measured changes in peripapillary retinal nerve fiber layer thickness may not represent the real gain or loss of the retinal nerve fiber layer. Therefore, the new retinal nerve fiber layer index, which corrects for the component of macula edema, could be a better means of assessing the changes of peripapillary retinal nerve fiber layer thickness in patients with diabetic macular edema.