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The aim of this study was to present the clinical and radiological characteristics, surgical management, and outcome in a large series of patients with aneurysms of the distal anterior cerebral artery (DACA) managed in the microsurgical era.The records of 1109 patients with anterior circulation aneurysms managed at the authors' institution between 1970 and 1998 were reviewed.Fifty-nine patients (5.3%) were identified with 67 DACA aneurysms. Seventy-three percent of the patients were women. The mean age of all patients was 47 years. Multiple aneurysms were identified in 51% of all patients, most commonly on the middle cerebral artery. Thirty-six patients had ruptured DACA aneurysms and 23 had unruptured aneurysms. In those with ruptured aneurysms, the admission grade was Grade I in 10 patients (27.8%), Grade II in three patients (8.3%), Grade III in 10 patients (27.8%), Grade IV in seven patients (19.4%), and Grade V in six patients (16.7%). Frontal lobe hematomas occurred in 28% of the patients with ruptured aneurysms and carried a poor prognosis. In those with unruptured aneurysms, 11 were incidental and 12 were identified after a subarachnoid hemorrhage from another aneurysm. The mean diameter was 10 mm in ruptured aneurysms and 5.8 mm in unruptured aneurysms. Fifty-eight patients underwent surgery and one patient was treated with endovascular coiling. Six patients, all with ruptured aneurysms, died. Seventy percent of survivors with ruptured aneurysms had a favorable outcome.DACA aneurysms possess a number of characteristics that distinguish them from the more common intracranial aneurysms. With modern neurosurgical and endovascular techniques, an acceptable operative morbidity and mortality can be achieved.