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Huang SX, Ai XP, Kang ZH, Chen ZY, Li RM, Wu ZC, Zhu F. Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms: A retrospective study of 24 patients. World J Clin Cases 2024; 12:2529-2541. [PMID: 38817240 PMCID: PMC11135433 DOI: 10.12998/wjcc.v12.i15.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Lobulated intracranial aneurysm is a special type of aneurysm with at least one additional cyst in the neck or body of the aneurysm. Lobulated intracranial aneurysm is a complex aneurysm with complex morphology and structure and weak tumor wall, which is an independent risk factor for rupture and hemorrhage. Lobular aneurysms located in the anterior communicating artery complex account for 36.9% of all intracranial lobular aneurysms. Due to its special anatomical structure, both craniotomy and endovascular treatment are more difficult. Compared with single-capsule aneurysms, craniotomy for lobular intracranial aneurysms has a higher risk and complication rate. AIM To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm (ACoAA). METHODS Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included. Their demographic, clinical and imaging characteristics, endovascular treatment methods and follow-up results were collected. RESULTS A total of 24 patients with ruptured lobulated ACoAA were included, including 9 males (37.5%) and 15 females (62.5%). Their age was 56.2 ± 8.9 years old (range 39-74). The time from rupture to endovascular treatment was 10.9 ± 12.5 h. The maximum diameter of the aneurysms was 5.1 ± 1.0 mm and neck width were 3.0 ± 0.7 mm. Nineteen patients (79.2%) were double-lobed and 5 (20.8%) were multilobed. Fisher's grade: Grade 2 in 16 cases (66.7%), grade 3 in 6 cases (25%), and grade 4 in 2 cases (8.3%). Hunt-Hess grade: Grade 0-2 in 5 cases (20.8%), grade 3-5 in 19 cases (79.2%). Glasgow Coma Scale score: 9-12 in 14 cases (58.3%), 13-15 in 10 cases (41.7%). Immediately postprocedural Raymond-Roy grade: grade 1 in 23 cases (95. 8%), grade 2 in 1 case (4.2%). Raymond-Roy grade in imaging follow-up for 2 wk to 3 months: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Follow-up for 2 to 12 months showed that 21 patients (87.5%) had good functional outcomes (modified Rankin Scale score ≤ 2), and there were no deaths. CONCLUSION Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.
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Affiliation(s)
- Sheng-Xuan Huang
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Xun-Ping Ai
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Ze-Hui Kang
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Zhi-Yong Chen
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Ren-Man Li
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Zu-Chao Wu
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
| | - Feng Zhu
- Department of Neurosurgery, Sanming First Hospital Affiliated to Fujian Medical University, Sanming 365000, Fujian Province, China
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Sturiale CL, Scerrati A, Ricciardi L, Rustemi O, Auricchio AM, Norri N, Piazza A, Raneri F, Benato A, Albanese A, Mangiola A, Zotta DC, D’Andrea G, Picotti V, Raco A, Volpin L, Trevisi G. Geometry and Symmetry of Willis' Circle and Middle Cerebral Artery Aneurysms Development. J Clin Med 2024; 13:2808. [PMID: 38792350 PMCID: PMC11122484 DOI: 10.3390/jcm13102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: A relationship between the geometry and symmetry of Willis' circle and intracranial aneurysms was reported for anterior communicating and posterior communicating (PCom) aneurysms. A similar association with the middle cerebral artery (MCA) aneurysms instead appeared weaker. Methods: We reviewed 432 patients from six Italian centers with unilateral MCA aneurysms, analyzing the relationship between the caliber and symmetry of Willis' circle and the presence of ruptured and unruptured presentation. CT-angiograms were evaluated to assess Willis' circle geometrical characteristics and the MCA aneurysm side, dimension and rupture status. Results: The hypoplasia of the first segment of the anterior cerebral artery (A1) was in approximately one-quarter of patients and PCom hypoplasia was in almost 40%. About 9% had a fetal PCom ipsilaterally to the aneurysm. By comparing the aneurysmal and healthy sides, only the PCom hypoplasia appeared significantly higher in the affected side. Finally, the caliber of the internal carotid artery (ICA) and the first segment of MCA (M1) caliber were significantly greater in patients with unruptured aneurysms, and PCom hypoplasia appeared related to the incidence of an ipsilateral MCA aneurysm and its risk of rupture. Conclusions: Although according to these findings asymmetries of Willis' circle are shown to be a risk factor for MCA aneurysm formation and rupture, the indifferent association with ipsilateral or contralateral hypoplasia remains a datum of difficult hemodynamic interpretation, thereby raising the concern that this association may be more casual than causal.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Oriela Rustemi
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
- Department of Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nicolò Norri
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Amedeo Piazza
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Fabio Raneri
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Alberto Benato
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.L.S.); (A.A.)
| | - Annunziato Mangiola
- Department of Neurosciences, Imaging and Clinical Sciences, G. D’Annunzio University, 66100 Chieti, Italy
| | | | - Giancarlo D’Andrea
- Neurosurgical Unit, Spaziani Hospital, 03100 Frosinone, Italy; (G.D.); (V.P.)
| | - Veronica Picotti
- Neurosurgical Unit, Spaziani Hospital, 03100 Frosinone, Italy; (G.D.); (V.P.)
| | - Antonino Raco
- Neurosurgical Unit, NESMOS Department, Sapienza University of Rome, 00161 Rome, Italy; (L.R.); (A.P.)
| | - Lorenzo Volpin
- Department of Neurosurgery, San Bortolo Hospital, 36100 Vicenza, Italy; (O.R.); (F.R.)
| | - Gianluca Trevisi
- Department of Neurosciences, Imaging and Clinical Sciences, G. D’Annunzio University, 66100 Chieti, Italy
- Neurosurgical Unit, Ospedale Spirito Santo, 65122 Pescara, Italy
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The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory. Acta Neurochir (Wien) 2023; 165:501-515. [PMID: 36652012 DOI: 10.1007/s00701-023-05487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE An anterior communicating artery is a common location for both ruptured and unruptured intracranial aneurysms, and microsurgery is sometimes necessary for their successful treatment. However, postoperative infarction should be considered during clipping due to the complex surrounding structures of anterior communicating artery aneurysms. This study aimed to evaluate the risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms and its clinical outcomes. METHODS The data of patients who underwent microsurgical clipping of an unruptured anterior communicating artery aneurysm in our hospital between January 2008 and December 2020 were retrospectively analyzed. The patients' demographic data, anatomical features of the anterior communicating artery complex and aneurysm, surgical technique, characteristics of postoperative infarction, and its clinical course were evaluated. RESULTS Notably, among 848 patients, 66 (7.8%) and 34 (4%) patients had radiologic and symptomatic infarctions, respectively. Univariate and multivariate logistic regression analyses showed that hypertension (odds ratio (OR), 1.99; [Formula: see text]), previous stroke (OR, 3.89; [Formula: see text]), posterior projection (OR, 5.58; [Formula: see text]), aneurysm size (OR, 1.17; optimal cut-off value, 6.14 mm; [Formula: see text]), and skull base-to-aneurysm distance (OR, 1.15; optimal cut-off value, 11.09 mm; [Formula: see text]) were associated with postoperative infarction. In the pterional approach, a closed A2 plane was an additional risk factor (OR, 1.88; [Formula: see text]). Infarction of the subcallosal and hypothalamic branches was significantly associated with symptomatic infarction ([Formula: see text]). CONCLUSION Hypertension, previous stroke, posteriorly projecting aneurysms, aneurysm size, and highly positioned aneurysms are independent risk factors for postoperative infarction during surgical clipping of an unruptured anterior communicating artery aneurysm. Additionally, a closed A2 plane is an additional risk factor of postoperative infarction in patients undergoing clipping via the pterional approach.
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Feng L, Mao HJ, Zhang DD, Zhu YC, Han F. Anatomical variations in the Circle of Willis and the formation and rupture of intracranial aneurysms: A systematic review and meta-analysis. Front Neurol 2023; 13:1098950. [PMID: 36726753 PMCID: PMC9885143 DOI: 10.3389/fneur.2022.1098950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
Background The anterior (AcomA) and posterior communicating arteries (PcomA) are two of the most frequent sites for intracranial aneurysms. Anatomical variations in the Circle of Willis (COW) are frequently observed in patients with AcomA and PcomA aneurysms. Strong evidence is needed to determine the pooled estimate of the effect of COW variations on the formation and rupture of these aneurysms. Aim This systematic review and meta-analysis aimed to establish the effect of COW variations on the formation and rupture of AcomA and PcomA aneurysms using available studies. Summary of review PubMed, Embase, and Web of Science databases were systematically searched for studies published in English before September 21, 2022. Studies investigating AcomA aneurysms and the hypoplastic/aplastic A1 segment of the anterior cerebral artery and PcomA aneurysms and hypoplastic/aplastic PcomA or fetal-type posterior cerebral artery (FTP) were included. The heterogeneity of the studies was assessed using Cochran Q-test and I2 statistic. Pooled estimate was assessed using either a random- or fixed-effects model based on the heterogeneity of the studies. Among the 4,932 studies, 21 were eligible and included in the analysis. The presence of hypoplastic/aplastic A1 was significantly correlated with the formation [OR (95% confidence interval [CI]) = 7.97 (5.58, 11.39), P < 0.001] and rupture [OR (95%CI) = 1.87 (1.29, 2.72), P < 0.001] of AcomA aneurysms. Significant associations between FTP and both the formation [OR (95%CI) = 2.15 (1.41, 3.30), P < 0.001] and rupture [OR (95%CI) = 1.72 (1.26, 2.36), P < 0.001] of PcomA aneurysms were observed. Conclusions Significant associations were observed between COW variations and both the formation and rupture of AcomA and PcomA aneurysms. This can help in determining interventions for patients with aneurysms. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225149, identifier: CRD42021225149.
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Affiliation(s)
- Lu Feng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He-Jiao Mao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Fei Han ✉
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Sungkaro K, Tunthanathip T, Taweesomboonyat C, Kaewborisutsakul A. Surgical outcomes of patients after treatment of ruptured anterior communicating artery aneurysms: "real-world" evidence from southern Thailand. Chin Neurosurg J 2021; 7:42. [PMID: 34598732 PMCID: PMC8487142 DOI: 10.1186/s41016-021-00259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022] Open
Abstract
Background Anterior communicating artery (AComA) aneurysm rupture is the most common cause of subarachnoid hemorrhage worldwide. In this study, we aimed to determine the factors associated with a poor clinical outcome in patients with ruptured AComA aneurysms undergoing microsurgical clipping. Methods We retrospectively reviewed the clinical and radiologic features as well as clinical outcomes of 150 consecutive patients with ruptured AComA aneurysm who underwent surgical clipping during the 11-year study period. Logistic regression analysis was performed to identify independent factors associated with unfavorable clinical outcomes (defined as a modified Rankin scale score of 3–6). Results The study included 83 male and 67 female patients, with a mean age of 51.3 ± 11.5 years. At admission, most of the patients had good neurological status, including 97 (64.7%) patients with a Hunt and Hess grade of 1 or 2 and 109 (72.6%) patients with a World Federation of Neurosurgical Societies grade of 1 or 2. Unfavorable outcomes at 6 months were observed in 23 (22.0%) patients, and the 6-month mortality rate was 8.0%. Multivariate analysis showed that preoperative intraventricular hemorrhage (odds ratio [OR], 19.66; 95% confidence interval [CI], 5.10–75.80; P < 0.001), A1 hypoplasia (OR, 8.90; 95% CI, 2.82–28.04; P < 0.001), and postoperative cerebral infarction (OR, 3.21; 95% CI, 1.16–8.88; P = 0.025) were strong independent risk factors for unfavorable outcomes. Conclusions Proper management of preoperative intraventricular hemorrhage, A1 hypoplasia, and intensive care for postoperative brain infarction are warranted for improved surgical outcomes in patients with ruptured AComA aneurysm undergoing surgical clipping.
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Affiliation(s)
- Kanisorn Sungkaro
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanit Street, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand
| | - Thara Tunthanathip
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanit Street, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand
| | - Chin Taweesomboonyat
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanit Street, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand
| | - Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanit Street, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand.
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Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
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Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Chen J, Li M, Zhu X, Chen Y, Zhang C, Shi W, Chen Q, Wang Y. Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies. Front Neurol 2020; 11:1020. [PMID: 33013671 PMCID: PMC7509403 DOI: 10.3389/fneur.2020.01020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022] Open
Abstract
Anterior communicating artery aneurysms account for 23–40% of ruptured intracranial aneurysms and 12–15% of unruptured aneurysms and are the most common intracranial ruptured or unruptured aneurysms. Because they have relatively complex anatomical structures and anatomical variations and are adjacent to important blood vessels and structures, in the process of microsurgical exposure of an Anterior communicating artery aneurysm, attention should be paid not only to the anatomical characteristics of the aneurysm itself but also to the adjacent important blood vessels and perforating arteries; therefore, both surgical clipping and endovascular embolization are serious challenges for neurosurgeons. No matter which treatment is chosen, it is necessary to determine the structure of the Anterior communicating artery and its perforating arteries as well as whether there is a fenestration deformity of the Anterior communicating artery and the relationship between bilateral A1-A2 before surgery. The shape and size of the aneurysm itself and its location relative to adjacent blood vessels also need to be considered to better complete the procedure, and this is especially true for microsurgical clipping. Clarifying the anatomy before surgery is helpful for better selecting the surgical approach and surgical side, which could affect the intraoperative exposure of the aneurysm and adjacent arteries, the surgical difficulty, the resection rate, and the postoperative complications. Therefore, starting with Anterior communicating artery aneurysms and their adjacent structures and variations, this paper reviews the latest progress in surgical treatment based on anatomic specificity as well as the most recent clinical studies.
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Affiliation(s)
- Junhui Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Mingchang Li
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Xun Zhu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Chen
- Department of Internal Medicine, Hexian Hospital of Traditional Chinese Medicine, Ma'anshan, China
| | - Chunlei Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenwen Shi
- Department of Internal Medicine, Hexian Hospital of Traditional Chinese Medicine, Ma'anshan, China
| | - Qianxue Chen
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Yuhai Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Nussbaum ES, Touchette JC, Madison MT, Goddard JK, Lassig JP, Nussbaum LA. Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature. Oper Neurosurg (Hagerstown) 2020; 19:678-690. [DOI: 10.1093/ons/opaa214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
With advances in endovascular techniques, the relative roles of microsurgery and endovascular therapy in the management of intracranial aneurysms have become less clear, and data regarding treatment-specific outcomes are increasingly important.
OBJECTIVE
To describe our experience with microsurgery in a large series of unruptured anterior communicating artery aneurysms (ACOMMAAs) and detail our treatment decision-making process based on individual aneurysm morphology.
METHODS
We retrospectively reviewed unruptured ACOMMAAs treated microsurgically at our center between 1997 and 2018, recording aneurysm size, surgical approach, occlusion rates, neurological outcomes, and complications.
RESULTS
We treated 300 unruptured ACOMMAAs in 300 patients, mean age 49 yr, 180 (60.0%) female, including 245 (81.7%) small, 50 (16.7%) large, and 5 (1.7%) giant aneurysms. Most underwent a pterional approach (253, 84.3%), with orbitozygomatic or anterior interhemispheric approaches in 35 (11.7%) and 12 (4%), respectively. Greater than 95% occlusion was achieved in 284 (94.7%), 90% to 95% occlusion in 13 (4.3%), and 3 (1.0%) underwent wrapping. Serious complications occurred in 3 patients (1.0%) resulting in 2 deaths (0.7%), and minor complications in 12 (4.0%). At final follow-up, good neurological outcome was observed in 297 (99.0%) patients.
CONCLUSION
Given clinical equipoise regarding optimal treatment of unruptured ACOMMAAs, this work provides a benchmark for achievable microsurgical outcomes. Future surgical/endovascular studies should separate results of ruptured and unruptured lesions and describe aneurysm morphology to allow for better comparison of outcomes between treatments. We suggest that open microsurgery represents an important option for select, morphologically complex ACOMMAAs, and that a multidisciplinary approach offers optimal patient outcomes.
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Affiliation(s)
- Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, Twin Cities, Minnesota
| | | | | | | | | | - Leslie A Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, Twin Cities, Minnesota
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