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Policicchio D, Boccaletti R, Dipellegrini G. CTA-based 3D virtual model for preoperative simulation and intraoperative neuronavigation in the surgical treatment of distal anterior cerebral artery aneurysms. J Clin Neurosci 2024; 127:110756. [PMID: 39067368 DOI: 10.1016/j.jocn.2024.110756] [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: 05/22/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE This study aims to assess the efficacy and limitations of Computed Tomography Angiography (CTA)-based 3D virtual models for preoperative simulation and intraoperative neuronavigation in the surgical treatment of Distal Anterior Cerebral Artery (DACA) Aneurysms. METHODS A retrospective observational study was conducted, analyzing patients who underwent surgical clipping of DACA aneurysms via an interhemispheric approach from 2016 to 2022. Outcomes measured included qualitative analyses of 3D reconstructions against actual intraoperative anatomy, neuronavigator accuracy, 6-month modified Rankin Scale (mRS), complete exclusion rates, and surgical complications. Patient demographics, clinical characteristics, surgical timing, and intraoperative data were meticulously documented for analysis. RESULTS Fifteen patients were included in the study, with a mean age of 52 years. The mean Hunt-Hess score at admission was 2.2, encompassing 2 unruptured and 13 ruptured aneurysms. Intraoperative anatomical visualization perfectly matched the preoperative 3D model in 13 cases, with discrepancies in two. Neuronavigation demonstrated a mean accuracy of 1.76 mm, remaining consistent in 14 patients, and accurately tracking the planned trajectory. Postoperative complications occurred in 26.5 % of patients, including two fatalities, with no navigation-related complications. Incomplete aneurysm occlusion was observed in one case. The mean mRS score at 6 months was 2.46. CONCLUSIONS The employment of 3D CTA for preoperative simulation and intraoperative neuronavigation holds significant potential in enhancing the surgical management of DACA aneurysms. Despite some discrepancies and technical limitations, the overall precision of preoperative simulations and the strategic value of intraoperative neuronavigation highlight their utility in improving surgical outcomes.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria "Renato Dulbecco" di Catanzaro, Italy.
| | - Riccardo Boccaletti
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Italy
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Sharma GR, Karki P, Joshi S, Paudel P, Shah DB, Baburam P, Bidhan G. Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms. Asian J Neurosurg 2023; 18:557-566. [PMID: 38152539 PMCID: PMC10749838 DOI: 10.1055/s-0043-1771371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking ( p -value 0.03) and use of temporary clip ( p -value 0.00) were significant predictors for unfavorable outcome. Conclusion The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.
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Affiliation(s)
| | - Prasanna Karki
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Sumit Joshi
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Prakash Paudel
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | | | - Pokharel Baburam
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Gyawali Bidhan
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
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Menon G, Srinivasan S, Pai A, Hegde A. Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms. Clin Neurol Neurosurg 2023; 226:107598. [PMID: 36706678 DOI: 10.1016/j.clineuro.2023.107598] [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: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Aneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. METHODS Retrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. RESULT Our cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0-3) and three (16.7%) had a poor outcome (mRS > 3). CONCLUSION The mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.
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Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
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Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience. J Stroke Cerebrovasc Dis 2022; 31:106811. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
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Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary Management of Distal Anterior Cerebral Artery Aneurysms: A Dual-Trained Neurosurgeon's Perspective. J Neurosci Rural Pract 2021; 12:711-717. [PMID: 34737505 PMCID: PMC8559076 DOI: 10.1055/s-0041-1735823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objectives Distal anterior cerebral artery (DACA) aneurysms are a subset of aneurysms located in the anterior circulation but away from the circle of Willis. We analyze the clinical presentation and outcomes of two treatment groups-surgical and endovascular-for DACA aneurysms managed by a dual-trained neurosurgeon. Material and Methods A retrospective evaluation of radiological and operative/interventional data of 34 patients with 35 DACA aneurysms over a 12-year period was analyzed. Twenty-seven patients underwent surgery, whereas seven underwent endovascular coiling of the aneurysms. Modified Fisher grade and World Federation of Neurosurgical Societies scale (WFNS) were used to note the subarachnoid hemorrhage (SAH) severity. Statistical Analysis Categorical data were presented as frequency and percentage, while noncategorical data were represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using Chi-square test, and p < 0.05 was considered statistically significant. Results Of 34 patients, 33 presented with a bleed and 23.5% patients were noted to have another aneurysm in addition to the DACA aneurysm. Patients who underwent clipping for another aneurysm along with the DACA aneurysm in a single surgical exercise had a poor outcome compared with those who underwent surgery for the lone DACA aneurysm (7 vs. 20, p = 0.015). Most patients in both surgical (70.37%) and endovascular (85.71%) groups had good outcome (mRS ≤ 2). Conclusions A good outcome can be achieved with either surgery or endovascular coiling in the management of DACA aneurysms. In patients with multiple aneurysms, SAH with aneurysmal rupture of DACA should be managed first; the other unruptured aneurysm may be operated after an interval to avoid morbidity.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dravya Jayakumar
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Parichay J Perikal
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Take Y, Kamide T, Kikkawa Y, Ikegami M, Teranishi A, Ehara T, Shibata A, Suzuki K, Ikeda T, Iihoshi S, Kohyama S, Kurita H. Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms. Surg Neurol Int 2021; 12:171. [PMID: 34084599 PMCID: PMC8168794 DOI: 10.25259/sni_223_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Distal anterior cerebral artery (ACA) aneurysms are rare, representing 1–9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. We clarified the clinical features and treatment outcomes of patients with ruptured distal ACA aneurysms according to the treatment options at our institute. Methods: Thirty-seven consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms who underwent surgical clipping or coil embolization between 2012 and 2018 were included in the study. Clinical presentations, radiographic findings, and outcomes were retrospectively reviewed and compared between patients who underwent either surgical clipping or coil embolization. Risk factors associated with poor outcomes (modified Rankin Scale 4–6) were analyzed using multiple regression analysis. Results: Nineteen patients (51.4%) had World Federation Neurological Surgeons (WFNS) Grade IV-V, 18 (48.7%) had frontal lobe hematomas, and 13 (35.1%) had multiple aneurysms. Surgical clipping and endovascular coiling were performed in 28 (75.7%) and nine (24.3%) patients, respectively. Aneurysms located at the A4-5 portions were mainly treated by surgical clipping (P = 0.04). There were no significant between-group differences in procedure-related morbidity and mortality; however, the complete occlusion rate was higher in the surgical group (P < 0.01). Overall, a favorable neurological outcome at discharge (mRS 0–3) was obtained in 23 patients (62.5%). Multiple regression analysis revealed that WFNS Grade IV-V and frontal lobe hematomas were risk factors for poor outcomes (mRS 4–6). Conclusion: Acceptable outcomes were obtained in 62.5% of cases, and there were no significant between-group differences in treatment results between clipping and coiling. A poor WFNS grade and intracerebral hematomas were risk factors for a poor prognosis.
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Affiliation(s)
- Yushiro Take
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masaki Ikegami
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Akio Teranishi
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takuro Ehara
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Aoto Shibata
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshiki Ikeda
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Satoshi Iihoshi
- Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shinya Kohyama
- Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Neurosurgical Clipping versus Endovascular Coiling for Patients with Intracranial Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:e191-e222. [DOI: 10.1016/j.wneu.2020.02.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/20/2022]
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Kang XK, Guo SF, Lei Y, Wei W, Liu HX, Huang LL, Jiang QL. Endovascular coiling versus surgical clipping for the treatment of unruptured cerebral aneurysms: Direct comparison of procedure-related complications. Medicine (Baltimore) 2020; 99:e19654. [PMID: 32221092 PMCID: PMC7220217 DOI: 10.1097/md.0000000000019654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Endovascular coiling and surgical clipping are routinely used to treat unruptured cerebral aneurysms (UCAs). However, the evidence to support the efficacy of these approaches is limited. We aimed to analyze the efficacy of endovascular coiling compared with surgical clipping in patients with UCAs. METHOD A systematic search of 4 databases was conducted to identify comparative articles involving endovascular coiling and surgical clipping in patients with UCAs. We conducted a meta-analysis using the random-effects model when I> 50%. Otherwise, a meta-analysis using the fixed-effects model was performed. RESULTS Our results showed that endovascular coiling was associated with a shorter length of stay (WMD: -4.14, 95% CI: (-5.75, -2.531), P < .001) and a lower incidence of short-term complications compared with surgical clipping (OR: 0.518; 95% CI (0.433, 0.621); P < .001), which seems to be a result of ischemia complications (OR: 0.423; 95% CI (0.317, 0.564); P < .001). However, surgical clipping showed a higher rate of complete occlusion after surgery, in both short-term (OR: 0.179, 95% CI (0.064, 0.499), P = .001) and 1-year follow-ups (OR: 0.307, 95% CI (0.146, 0.646), P = .002), and a lower rate of short-term retreatment (OR: 0.307, 95% CI (0.146, 0.646), P = .002). Meanwhile, there was no significant difference in postoperative death, bleeding, and modified Rankin Scale (mRS) > 2 between the 2 groups. CONCLUSIONS The latest evidence illustrates that surgical clipping resulted in lower retreatment rates and was associated with a higher incidence of complete occlusion, while endovascular coiling was associated with shorter LOS and a lower rate of complications, especially ischemia.
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Affiliation(s)
- Xiao-kui Kang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong
| | - Sheng-fu Guo
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong
| | - Yi Lei
- Department of Gynaecology and Obstetrics, Anyi County People's Hospital, Nanchang
| | - Wei Wei
- Department of Neurology, Mianyang Central Hospital, Sichuan
| | | | - Li-li Huang
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Qun-long Jiang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong
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Endovascular treatment of distal anterior cerebral artery aneurysms: Long-term results. J Neuroradiol 2020; 47:33-37. [DOI: 10.1016/j.neurad.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/07/2018] [Accepted: 12/08/2018] [Indexed: 11/18/2022]
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Operative Management of Distal Anterior Cerebral Artery Aneurysms Through a Mini Anterior Interhemispheric Approach. World Neurosurg 2017; 108:519-528. [PMID: 28919562 DOI: 10.1016/j.wneu.2017.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, are present in 1.5%-9% of all intracranial aneurysms. Here we characterize the important microsurgical anatomy of DACAs; describe the surgical approach to treating these aneurysms with a minimally invasive surgical technique, the mini anterior interhemispheric approach (MAIA); and examine the nuances of aneurysm clipping in this region. METHODS This was a retrospective and descriptive analysis of a series of aneurysm surgeries performed at the National Institute of Neurology and Neurosurgery in Mexico City. Cadaveric dissections were used to demonstrate relevant cerebrovascular anatomy. We analyzed patient demographic data and aneurysm characteristics. Patients' neurologic grade was evaluated using the Hunt and Kosnik (H-K) scale, and surgical outcomes were evaluated using the Glasgow Outcome Scale (GOS). Other variables were analyzed using the χ2 test. RESULTS We analyzed a total of 32 DACA aneurysms (10 nonruptured and 22 ruptured), representing 5.8% of all aneurysms. The study cohort was 64.3% females and 35.7% males. H-K grade II was the most frequent classification (32.4%); 42.8% of patients presented with a Fisher grade IV aneurysm. Aneurysm location was classified as supra-genu, genu, or infra-genu. Eight patients had multiple aneurysms, among which 50% were located at the bifurcation of the middle cerebral artery. CONCLUSIONS Surgical clipping through a MAIA approach is an excellent treatment option for pericallosal artery aneurysms.
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Fotakopoulos G, Tsianaka E, Fountas K, Makris D, Spyrou M, Hernesniemi J. Clipping Versus Coiling in Anterior Circulation Ruptured Intracranial Aneurysms: A Meta-Analysis. World Neurosurg 2017; 104:482-488. [PMID: 28526647 DOI: 10.1016/j.wneu.2017.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate open surgical versus endovascular repair of anterior circulation ruptured intracranial aneurysms based on operative mortality, permanent neurologic deficit, late mortality, and need for reintervention. METHODS This meta-analysis included articles published since December 6, 2016, that compared outcomes of the 2 methods. Extracted data were organized in a standard table format, including first author, country, covered study period, publication year, number of patients and patients at follow-up, operative mortality rate (with 30 days from treatment), permanent neurologic deficit (appearing after surgery), late mortality (after 1 month), and reintervention (surgery or coiling) for both groups of patients. Follow-up was at least 1 year. RESULTS There were 8 articles that matched our study criteria. The study population was 628 patients; 374 were treated with surgical clipping, and 254 were treated with endovascular coiling. Pooled results showed no statistically significant difference between the 2 groups in terms of operative mortality, permanent neurologic deficit, late mortality, and need for reintervention. CONCLUSIONS Selection of the appropriate procedure must be made on the basis of the special characteristics of each case.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece.
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Demosthenes Makris
- Department of Head of Critical Care, University of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Dinc N, Lescher S, Quick-Weller J, Berkefeld J, Platz J, Senft C, Seifert V, Konczalla J. Outcome, Prognostic Factors, and Follow-Up Results After Subarachnoid Hemorrhage from Pericallosal Artery Aneurysms. World Neurosurg 2017; 99:566-571. [DOI: 10.1016/j.wneu.2016.12.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/17/2016] [Accepted: 12/18/2016] [Indexed: 10/20/2022]
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13
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Petr O, Coufalová L, Bradáč O, Rehwald R, Glodny B, Beneš V. Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2016; 100:557-566. [PMID: 27923755 DOI: 10.1016/j.wneu.2016.11.134] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. OBJECTIVE We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies of DACA aneurysms. METHODS A systematic search of Medline, Embase, Scopus, and Web of Science was performed for studies published from January 2000 to August 2015. We included studies describing treatment of DACA aneurysms with ≥10 patients. Random effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality and stroke rates, aneurysm recurrence/rebleed, and long-term neurologic morbidity/mortality. RESULTS Thirty studies with 1329 DACA aneurysms were included. Complete occlusion was 95% (95% confidence interval [CI], 91.0%-97.0%) in the surgical group and 68% (95% CI, 56.0%-78.0%) in the endovascular group (P < 0.0001). Aneurysm recurrence occurred in 3% (95% CI, 2.0%-4.0%) after surgery and in 19.1% (95% CI, 12.0%-27.0%) after endovascular treatment (P < 0.0001). Overall neurologic morbidity and mortality were 15% (95% CI, 11.0%-21.0%) and 9% (95% CI, 7.0%-11.0%) after surgery and 14% (95% CI, 10.0%-19.0%) (P = 0.725) and 7% (95% CI, 5.0%-10.0%) (P = 0.422) after endovascular treatment, respectively. Overall long-term favorable neurologic outcome was 80% and it was equal in both groups (80%; 95% CI, 73.0%-85.0% in the surgical group and 80%; 95% CI, 72.0%-87.0% in the endovascular group) (P = 0.892). CONCLUSIONS Our meta-analysis showed that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes. There were no substantial differences in procedure-related morbidity and mortality. These findings are important because they suggest that therapy of DACA aneurysms should be performed on a selective, case-by-case basis to maximize patient benefits.
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Affiliation(s)
- Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Austria; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Lucie Coufalová
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic; Department of Anesthesiology, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
| | - Rafael Rehwald
- Department of Radiology, Medical University Innsbruck, Austria
| | - Berharnd Glodny
- Department of Radiology, Medical University Innsbruck, Austria
| | - Vladimír Beneš
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
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Bhogal P, Martinez Moreno R, Ganslandt O, Bäzner H, Henkes H, Perez MA. Use of flow diverters in the treatment of unruptured saccular aneurysms of the anterior cerebral artery. J Neurointerv Surg 2016; 9:283-289. [PMID: 27789789 PMCID: PMC5339572 DOI: 10.1136/neurintsurg-2016-012648] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few publications have dealt exclusively with the use of flow diverter stents for the treatment of aneurysms of the anterior cerebral artery (ACA). OBJECTIVE To determine the efficacy of flow-diverting stents in the treatment of small, unruptured aneurysms of the ACA. METHODS We retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular aneurysm of the ACA between September 2009 and July 2016. The aneurysm fundus size, neck size, number and type of flow-diverting stent (FDS), complications, and follow-up data were recorded. RESULTS In total 26 patients, with 27 aneurysms were identified that matched our inclusion criteria (11 male and 15 female). The average age of the patients was 59.3 years (range 27-77 years). All patients, except one, had a single aneurysm affecting the ACA. Fourteen aneurysms were located on the left (51.9%). The average aneurysm fundus size was 2.9 mm (range 2-6 mm). Twenty patients had follow-up angiographic studies. In total, 16 aneurysms were completely excluded, 1 aneurysm showed a very small remnant, and no follow-up angiographic data are available for the remaining patients. One patient had a treatment-related complication. CONCLUSIONS Treatment of aneurysms arising from the ACA with flow diverters is technically feasible and carries a high degree of success with low complication rate.
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Affiliation(s)
- P Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - R Martinez Moreno
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - O Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Duisburg-Essen, Germany
| | - M Aguilar Perez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
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15
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Ko JK, Kim HS, Choi HJ, Lee TH, Yun EY, Choi CH. Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms. J Korean Neurosurg Soc 2015; 58:197-204. [PMID: 26539261 PMCID: PMC4630349 DOI: 10.3340/jkns.2015.58.3.197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 11/27/2022] Open
Abstract
Objective Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome.
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Affiliation(s)
- Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hwan Soo Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Hong Lee
- Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Yun
- Department of Biostatistics, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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16
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Ruan C, Long H, Sun H, He M, Yang K, Zhang H, Mao B. Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis. Br J Neurosurg 2015; 29:485-92. [PMID: 26037936 DOI: 10.3109/02688697.2015.1023771] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND With increasing use of high-resolution imaging of brain, unruptured aneurysms are more and more frequently detected. With the advances in treatment techniques, an increasing number of aneurysms are now occluded using endovascular coiling instead of conventional surgical clipping. However, the better modality for unruptured intracranial aneurysm has been poorly understood. OBJECTIVE The objective of this meta-analysis was to compare the outcomes between endovascular coiling and surgical clipping among patients with unruptured intracranial aneurysms. METHODS PubMed, Embase, Web of Science, CENTRAL, and SIGLE were electronically searched from January 1, 1990 to March 13, 2012 with no language restriction for randomized or nonrandomized clinical controlled trials. Article screening and data extraction were conducted in duplicate. Results were statistically pooled through Review Manager 5 and StatsDirect 2.7.9. RESULTS Seven studies met our inclusion criteria. The pooled risk ratios (coiling vs. clipping) were 0.59 (95% CI = 0.23-1.54) for death; 0.37 (95% CI = 0.10-1.41) for bleeding; 0.78 (95% CI = 0.38-1.58) for cerebral ischemia; 0.87 (95% CI = 0.70-1.08) for occlusion of aneurysm; 0.53 (95% CI = 0.18-1.52) for independence in daily activities. The pooled rates of death, bleeding, ischemia, occlusion of aneurysm, and mRS no less than 3 were 1% (95% CI = 0-2%), 2% (95% CI = 0-5%), 8% (95% CI = 4-13%), 82% (95% CI = 64-95%), and 5% (95% CI = 1-10%) for endovascular coiling, respectively, and 1% (95% CI = 0-2%), 6% (95% CI = 3-10%), 9% (95% CI = 5-15%), 95% (95% CI = 90-98%), and 8% (95% CI = 3-14%) for surgical clipping, respectively. We failed to evaluate quality of life and cognitive outcome due to insufficient data. Both meta-regression and sensitivity analysis showed consistent results. Furthermore, Begg's test and Egger's test failed to detect publication bias. CONCLUSION We suggest that endovascular coiling and surgical clipping bear similar risk ratios of death, bleeding, cerebral ischemia, occlusion of aneurysm, and independence in daily activities and encourage further studies on quality of life and cognitive outcome. However, albeit the results in this meta-analysis are robust, due to great clinical heterogeneity and low quality of studies, the results in this meta-analysis should be interpreted with caution.
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Affiliation(s)
- Changhu Ruan
- a Department of Neurosurgery , West China Hospital, Sichuan University , Chengdu , China
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17
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Surgical treatment of distal anterior cerebral artery aneurysms aided by electromagnetic navigation CT angiography. Neurosurg Rev 2015; 38:523-30; discussion 530. [DOI: 10.1007/s10143-015-0611-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/03/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
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18
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Oishi H, Nonaka S, Yamamoto M, Arai H. Feasibility and efficacy of endovascular therapy for ruptured distal anterior cerebral artery aneurysms. Neurol Med Chir (Tokyo) 2014; 53:304-9. [PMID: 23708221 DOI: 10.2176/nmc.53.304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Surgical clipping has been the primary treatment option for ruptured distal anterior cerebral artery (DACA) aneurysms. Therefore, the literature on endovascular therapy is sparse. The present study investigated the feasibility and efficacy of endovascular therapy for ruptured DACA aneurysms in 31 patients, 26 females and 5 males (mean age 63.2 ± 12.6 years). Mean aneurysm size and neck width were 4.8 ± 2.3 mm and 2.2 ± 0.7 mm, respectively. The Hunt and Hess (H/H) grades just prior to the treatment were scored as H/H grades 1-3 in 20 patients and H/H grades 4-5 in 11 patients. Fifteen patients had an intraparenchymal hematoma (IPH) surrounding the ruptured aneurysm on the initial computed tomography. Overall, 22 patients had a modified Rankin scale (mRS) score of 0-2 and 9 had a mRS score of 3-6 at discharge. H/H grade was closely related to the clinical outcomes, whereas the presence of IPH was not. Overall immediate angiographic outcomes were complete occlusion in 15, residual neck in 11, and residual aneurysm in 5. The overall recurrence rate was 35.3%. Complications including posttreatment rebleeding occurred in 5 patients. Symptomatic vasospasm occurred in 1 of the 18 patients with H/H grades 1-3. Endovascular therapy of ruptured DACA aneurysms is feasible and effective. However, the risks of recurrence and posttreatment bleeding remain to be resolved.
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Affiliation(s)
- Hidenori Oishi
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
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19
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Sturiale CL, Brinjikji W, Murad MH, Cloft HJ, Kallmes DF, Lanzino G. Endovascular treatment of distal anterior cerebral artery aneurysms: single-center experience and a systematic review. AJNR Am J Neuroradiol 2013; 34:2317-20. [PMID: 23868164 DOI: 10.3174/ajnr.a3629] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, a single center's experience of 20 patients and a systematic review and a meta-analysis of 16 studies, including 279 patients/aneurysms, assessed the safety and efficacy of endovascular treatment of distal anterior cerebral artery aneurysms. The authors conclude that endovascular treatment of distal anterior cerebral artery aneurysms is associated with high angiographic occlusion rates, but the complication rates are higher compared with other aneurysms in the circle of Willis.
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20
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Cavalcanti DD, Abla AA, Martirosyan NL, McDougall CG, Spetzler RF, Albuquerque FC. Endovascular management of distal ACA aneurysms: single-institution clinical experience in 22 consecutive patients and literature review. AJNR Am J Neuroradiol 2013; 34:1593-9. [PMID: 23391842 DOI: 10.3174/ajnr.a3408] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Distal ACA aneurysms remain difficult to treat with endovascular therapy, but improved technology and experience allows for the treatment of some of these aneurysms with excellent results. The purpose of this study was to assess the status of endovascular treatment of distal ACA aneurysms by comparing our results with recent endovascular and microsurgical series of distal ACA aneurysms. MATERIALS AND METHODS Between 2000 and 2008, a total of 22 consecutive patients (14 women; mean age, 58.4 years) with distal ACA aneurysms underwent coil placement at Barrow Neurological Institute. Clinical presentations, radiographic findings, endovascular management, and outcomes were reviewed retrospectively. RESULTS Of the 22 patients, 13 (59%) presented with subarachnoid hemorrhage. Six patients were HH grade I or II, 1 was grade III, 5 were grade IV, and 1 was grade V. Frontal lobe hematomas occurred in 5 patients with ruptured aneurysms. The mean aneurysm size was 7.5 mm (range, 2.8-25 mm); 55% were smaller than 7 mm. Twelve aneurysms (55%) arose from the origin of the callosomarginal artery (55%). Complete occlusion was achieved in 50% of the cases and near-complete occlusion in 45%. The few periprocedural complications included 1 retroperitoneal hematoma and 1 intraoperative rupture. Four patients had thromboembolic events adequately treated intraprocedurally with abciximab. No deaths occurred in the patients treated. CONCLUSIONS The characteristics of the patients and aneurysms treated in our series were comparable to previous reports of endovascular treatment of ACA aneurysms with respect to rupture status. Periprocedural morbidity and mortality rates in our series fared well compared with previous reports, as did our combined rate of complete or near-complete occlusions. Recent advances in endovascular devices and techniques have improved outcomes of distal ACA aneurysms.
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Affiliation(s)
- D D Cavalcanti
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
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21
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Matsuzaki K, Uno M, Fujihara T, Miyamoto T, Yokosuka K, Toi H, Matsubara S, Hirano K. Ruptured distal accessory anterior cerebral artery aneurysm--case report. Neurol Med Chir (Tokyo) 2011; 51:839-42. [PMID: 22198106 DOI: 10.2176/nmc.51.839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old man presented with an extremely rare aneurysm arising from an accessory anterior cerebral artery (ACA) manifesting as sudden onset of headache lasting for 5 days. Neurological examination on admission revealed no abnormalities. Computed tomography showed subarachnoid hemorrhage of the interhemispheric fissure and intraparenchymal hematoma of the left cingulate gyrus. Magnetic resonance and cerebral angiography revealed a saccular aneurysm of the distal portion of the accessory ACA classified as the bihemispheric type. Neck clipping of the aneurysm was performed via an interhemispheric approach 17 days after symptom onset. The patient made a good postoperative recovery without neurological deficit. Distal accessory ACA aneurysms tend to arise from the first bifurcation and supply parietal branches. The aneurysms tend to occur on the bihemispheric type of distal accessory ACA. Hemodynamic stress may contribute to formation or development of these aneurysms.
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Affiliation(s)
- Kazuhito Matsuzaki
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
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22
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Sekerci Z, Sanlı M, Ergün R, Oral N. Aneurysms of the distal anterior cerebral artery: a clinical series. Neurol Neurochir Pol 2011; 45:115-20. [PMID: 21574114 DOI: 10.1016/s0028-3843(14)60021-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Distal anterior cerebral artery (DACA) aneurysms, also called pericallosal or A2 aneurysms, are rare and comprise about 1.5 to 9% of all intracranial aneurysms. In this study, a series of 10 patients with DACA aneurysms who were surgically treated in our clinic is presented and discussed, focusing on their clinical features and sur-gical outcomes. MATERIAL AND METHODS A total of 344 patients with cerebral aneurysms were operated on in our clinic and 10 patients (2.9%) with DACA aneurysms were studied retrospectively. All patients underwent a computed tomography (CT) scan followed by four-vessel digital subtraction angiography (DSA). RESULTS Initial CT revealed intracerebral haematoma (ICH) in 7 patients (70%) and in 2 of them the haematoma was over 3 cm in diameter. The pericallosal-callosomarginal bifurcation was the most common location in 9 patients (90%). Four cases (40%) showed multiple aneurysms. The mean waiting time for the operation was 4.8 days. Surgical clipping was performed in all the cases. Multiple aneurysms required two different craniotomies in the same session. The patients with ICH over 3 cm in diameter, in addition to poor preoperative grade, are likely to have a poor outcome, and so clinical grade is the definite factor affecting the surgical outcome of patients. CONCLUSIONS DACA aneurysms are usually small and bleeding occurs irrespective of their size because of the lack of resistant arachnoid membranes at the level of the pericallosal cisterns. All DACA aneurysms, even if very small in size or discovered incidentally, should be aggressively treated because of the high tendency to rupture.
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Affiliation(s)
- Zeki Sekerci
- Department of Neurosurgery, Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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23
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Vora N, Thomas AJ, Gupta R, Gologorsky Y, Panapitiya N, Jovin T, Jankowitz B, Kassam A, Horowitz M. Endovascular treatment of distal anterior cerebral artery aneurysms: technical results and review of the literature. J Neuroimaging 2010; 20:70-3. [PMID: 19018950 DOI: 10.1111/j.1552-6569.2008.00324.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We sought to report our technical success and complications in treating distal anterior cerebral artery (ACA) aneurysms with coil embolization. METHODS We retrospectively reviewed all patients undergoing coil embolization of distal ACA aneurysms from September 1999 to March 2008. Patients were assessed for subarachnoid hemorrhage, fundus size, and fundus-to-neck ratio (F/N) < 2 or >or= 2. Technical success for aneurysms was assessed according to established criteria immediately post-procedure and at 6-month angiographic follow-up. Post-procedural outcomes were measured using the modified Rankin Scale (mRS) at discharge. A mRS <or= 2 for ruptured aneurysms or no change from baseline for unruptured aneurysms was considered a good clinical outcome. RESULTS Based on an intention-to-treat principle, we attempted embolization of 28 distal ACA aneurysms in 26 patients and were technically successful in 26 aneurysms (93%). Our mean age was 58 +/- 11 years. Thirteen presented with acute rupture. Average aneurysm size was 5.7 +/- 2.8 mm in our cohort with 20/28 (71%) having an F/N >or= 2. Seventeen aneurysms with an F/N >or= 2 and 5 with an F/N < 2 were completely obliterated or had minimal neck remnants at the end of the procedure (79%). Fourteen aneurysms underwent 6-month angiographic follow-up and were either completely obliterated or had a minimal residual neck remnant. Clinical outcomes were good in 12/13 unruptured patients (93%) at the time of discharge and in 6/13 ruptured patients (46%) with 90-day follow-up. Three patients had ischemic complications that were considered non-disabling, and 2 patients died from complications related to their initial subarachnoid hemorrhage. Two patients had an aborted procedure from failure to catheterize the aneurysm. CONCLUSION Endovascular treatment of distal ACA aneurysms can achieve good technical and clinical outcomes.
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Affiliation(s)
- Nirav Vora
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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24
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Sanli AM, Cekirge S, Sekerci Z. Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass. J Neurosurg 2010; 114:1061-4. [PMID: 20635851 DOI: 10.3171/2010.6.jns10370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The ventricular system is a rare localization for intracranial aneurysms. Most ventricular aneurysms arise from a distal branch of the choroidal arteries and a major branch point of the circle of Willis. A 41-year-old-man suffering from dizziness of 2 weeks' duration was admitted to the clinic. On radiological examination, he had a well-circumscribed mass involving the frontal horn of the right lateral ventricle without radiological evidence of a prior or recent hemorrhage. Localization and radiological appearance were not typical of a ventricular mass and did not allow diagnosis. After cerebral angiography, an aneurysm arising from the distal anterior cerebral artery was incidentally found in an intraventricular location. This unruptured aneurysm was successfully treated via the endovascular route. The authors describe the unusual case of a distal anterior cerebral artery aneurysm with a dome extending into the right lateral ventricle, which appears to be the first such case in the literature. Angiography may be helpful to neurosurgeons in avoiding the disastrous complications of a biopsy procedure in such unusual cases.
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Affiliation(s)
- A Metin Sanli
- Department of Neurosurgery, Dιşkapι Yιldιrιm Beyazιt Hospital, Ankara, Turkey.
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25
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Jabbour PM, Tjoumakaris SI, Rosenwasser RH. Endovascular management of intracranial aneurysms. Neurosurg Clin N Am 2010; 20:383-98. [PMID: 19853799 DOI: 10.1016/j.nec.2009.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data from our clinical series and others supports the idea that endovascular coil embolization is a reliable form of treatment for both ruptured and unruptured cerebral aneurysms. This form of treatment appears from preliminary data to be protective against subarachnoid hemorrhage. Although not likely to replace open surgery, the continued advancements in technology and supportive clinical data will allow endovascular therapy to become a more durable mode of treatment.
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Affiliation(s)
- Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Jefferson Hospital for Neuroscience, 909 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA.
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26
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Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemelä M, Hernesniemi J. Distal Anterior Cerebral Artery Aneurysms. SURGICAL MANAGEMENT OF CEREBROVASCULAR DISEASE 2010; 107:15-26. [DOI: 10.1007/978-3-211-99373-6_3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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27
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Carvi y Nievas MN. The influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results: analysis of our casuistry and literature review. Neurol Res 2009; 32:73-81. [PMID: 19941732 DOI: 10.1179/016164110x12556180205951] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results. METHOD The influence of the aneurysm configuration (basic or complex configuration) and location (infracallosal or supracallosal) on the treatment-related radiological results (partial or complete aneurysm occlusion) and clinical outcome (favorable or unfavorable) was retrospectively analysed in all admitted patients with ruptured pericallosal aneurysms within the last 10 years. The expected benefit from each form of treatment was individually discussed. RESULTS During this period, 21 patients with ruptured pericallosal aneurysms (three previously coiled in other departments) had been admitted to our department. Within the endovascular group (ten patients), five infracallosal basic aneurysms presented a complete occlusion and favorable patient outcome. Three patients with infracallosal complex aneurysms presented a favorable outcome (two aneurysms were partially occluded and a frustrated procedure was replaced by clipping). Two supracallosal basic aneurysms showed a complete occlusion with one unfavorable outcome and one frustrated procedure followed by clipping and favorable outcome. In the surgical group (11 patients), five infracallosal complex aneurysms presented a complete occlusion with four favorable and one unfavorable outcomes. One patient with a supracallosal basic aneurysm presented a complete occlusion with a favorable outcome, and five patients with supracallosal complex aneurysms presented a complete occlusion in four cases and favorable outcome in all of them. CONCLUSION The results of this study suggest that patients with infracallosal basic configured aneurysms are expected to benefit from endovascular procedures, whereas better radiological and clinical results can be obtained in surgically treated patients harboring supra- or infracallosal aneurysms of complex configuration.
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28
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Clinical features and surgical outcomes of ruptured distal anterior cerebral artery aneurysms in 20 consecutively managed patients. J Clin Neurosci 2009; 16:802-6. [PMID: 19299140 DOI: 10.1016/j.jocn.2008.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 09/17/2008] [Accepted: 09/18/2008] [Indexed: 11/23/2022]
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29
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Lv X, Li Y, Jiang C, Jiang P, Wu Z. Dissecting aneurysm at the proximal anterior cerebral artery treated by parent artery occlusion. Interv Neuroradiol 2009; 15:123-6. [PMID: 20465942 PMCID: PMC3306144 DOI: 10.1177/159101990901500121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 10/26/2008] [Indexed: 02/05/2023] Open
Abstract
Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare. We described the first documented endovascular treatment of an A1 portion dissecting aneurysm by parent artery occlusion. A 43-year-old man patient presented with subarachnoid hemorrhage. Cerebral angiography demonstrated a dissecting aneurysm of the left anterior cerebral artery (ACA) at A1 portion. Because of the dissecting nature of the A1 portion aneurysm, a 2.5x15-mm Neuroform stent was placed in the left A1 portion. However, regrowth of the aneurysm was found on the three month follow-up angiogram, so the aneurysm and the left A1 portion of ACA were occluded completely.
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Affiliation(s)
- X Lv
- 2008B42, Beijing Nova Program, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
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30
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Microneurosurgical management of aneurysms at A4 and A5 segments and distal cortical branches of anterior cerebral artery. ACTA ACUST UNITED AC 2008; 70:352-67; discussion 367. [DOI: 10.1016/j.surneu.2008.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 03/01/2008] [Indexed: 11/23/2022]
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31
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Nambiar AP, Bozlar U, Angle JF, Jensen ME, Hagspiel KD. Initial Clinical Experience with Biopolymer-coated Detachable Coils (HydroCoil) in Peripheral Embolization Procedures. J Vasc Interv Radiol 2008; 19:995-1001. [DOI: 10.1016/j.jvir.2008.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 01/25/2008] [Accepted: 02/04/2008] [Indexed: 11/25/2022] Open
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