• Thomas Metayer, Vianney Gilard, Michel Piotin, Evelyne Emery, Alin Borha, Erwan Robichon, Anais R Briant, Stephane Derrey, Denis Vivien, and Thomas Gaberel.
• Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France. Electronic address: thomas.metayer@neurochirurgie.fr.
• World Neurosurg. 2023 Oct 1; 178: e174e181e174-e181.

BackgroundDistal anterior cerebral aneurysm (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available: microsurgery and endovascular therapy (EVT).ObjectiveTo compare the results between microsurgery and EVT in a modern French cohort.MethodsA multicenter retrospective cohort study of 3 French neurosurgical units was carried out from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment for a ruptured or unruptured DACA aneurysm.ResultsA total of 69 patients were included; 16 patients (23.2%) were treated by microsurgery and 53 (76.8%) were treated by EVT. Thirty-one patients (44.9%) had ruptured aneurysms. The complication rate was low, with 1 death and 1 symptomatic ischemia. There was no difference in complications between microsurgery and EVT (P = 0.22). The number of retreatments was higher in EVT (15% vs. 0%) but not significantly (P = 0.18).ConclusionsIn the specific subgroup of DACA, both treatment modalities are effective in ruptured and unruptured aneurysms, with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complications.Copyright © 2023 Elsevier Inc. All rights reserved.

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