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Takeda N, Kurihara E, Kuroda R, Inoue S, Lee TJ, Nakahara M, Nakamura N, Sasayama T. Rupture Risk Factors and Strategies for Unruptured Distal Anterior Cerebral Artery Aneurysms. World Neurosurg 2024; 182:e785-e791. [PMID: 38092353 DOI: 10.1016/j.wneu.2023.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Distal anterior cerebral artery (dACA) aneurysms are rare. Ruptured dACA aneurysms typically present with subarachnoid hemorrhage in conjunction with intracerebral hematoma and cause neurological deterioration. This study aimed to determine their risk of rupture and examine associated factors. METHODS We retrospectively analyzed patients with dACA aneurysms to compare patient and aneurysm characteristics between ruptured and unruptured aneurysms. Clinical outcome was used the modified Rankin scale. Univariate analyses were performed to identify rupture risk factors. RESULTS One hundred three patients with dACA aneurysms were examined (51 ruptured and 52 unruptured). The median aspect ratio of ruptured and unruptured aneurysms was 1.69 and 1.22, respectively (P < 0.01). The median maximum diameter of ruptured and unruptured aneurysms was 5.2 and 3.1 mm, respectively (P < 0.01). The median size ratio of ruptured and unruptured aneurysms was 3.32 and 2.17, respectively (P < 0.01). Maximum diameter was <5 mm in 45.2% of ruptured dACA aneurysms. dACA aneurysm, showing size ratio >2.4 and aspect ratio >1.4, had ruptured in 71.4% and 78.6%, respectively. We suggested that these are the threshold of size ratio and aspect ratio for rupture of dACA aneurysms. A total percentatge of 78.1% of aneurysms with aspect ratio >1.4 and size ratio >2.4 had ruptured. CONCLUSIONS Distal anterior cerebral artery (dACA) aneurysms may rupture, even when small. We found a significant difference between ruptured and unruptured aneurysms with respect to maximum diameter, aspect ratio, and size ratio. Treatment for small aneurysms should be considered based on size ratio and aspect ratio, not just size.
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Affiliation(s)
- Naoya Takeda
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan.
| | - Eiji Kurihara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Ryuichi Kuroda
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Satoshi Inoue
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Te-Jin Lee
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Masahiro Nakahara
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Naoto Nakamura
- Department of Neurosurgery, Junshin Hospital, Kakogawa, Hyogo, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University School of Medicine, Kakogawa, Hyogo, Japan
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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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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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Hani U, Bari ME, Bukhari SS. Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes. Surg Neurol Int 2020; 11:232. [PMID: 32874735 PMCID: PMC7451175 DOI: 10.25259/sni_27_2019] [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] [Received: 01/21/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder. Case Description A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient's neurological status did not improve, and he died following a complicated clinical course. Conclusion Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization.
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Affiliation(s)
- Ummey Hani
- Sindh Medical College, Jinnah Sindh Medical University, Sindh, Pakistan
| | - Muhammad Ehsan Bari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Sarmad Bukhari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Wedge Resection of the Falx to Clip a Distal Anterior Cerebral Artery Aneurysm. World Neurosurg 2020; 141:33-36. [PMID: 32454203 DOI: 10.1016/j.wneu.2020.05.135] [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: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The unilateral anterior interhemispheric approach has been widely used for distal anterior cerebral artery (DACA) aneurysms. However, there are some drawbacks of this approach because of the narrow operative field, including possible brain traction injury, bridging vein injury, and inadequate exposure of the aneurysm. Here, we report a case of a DACA aneurysm covered by the falx that could not be totally exposed with the unilateral interhemispheric approach. We successfully obtained a wide view with wedge resection of the falx, avoiding excessive brain traction and division of the superior sagittal sinus. CASE DESCRIPTION A 76-year-old woman with a 6-mm unruptured DACA aneurysm underwent a unilateral craniotomy with the anterior interhemispheric approach. In the operative field, the aneurysm was found at the midline, just below the falx. The aneurysm was covered by the falx and could not be completely exposed with the usual brain retraction. Therefore, we performed wedge resection of the falx, thus obtaining sufficient surgical field and totally exposing the aneurysm. We were then able to apply the clip successfully. Postoperative brain computed tomography angiography showed no remnant aneurysm sac or complications of falx resection or brain retraction, such as bleeding or vessel injury. CONCLUSIONS When an aneurysm is located just below the falx and is exposed inadequately, performing wedge resection of the falx can expose the aneurysms adequately for application of the clip.
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Pericallosal artery aneurysm - Case report, literature review and management outcome. Int J Surg Case Rep 2020; 68:32-35. [PMID: 32113168 PMCID: PMC7044651 DOI: 10.1016/j.ijscr.2020.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022] Open
Abstract
Pericallosal artery aneurysms are rare. They have a higher rupture rate than other anterior circulation intracranial aneurysms. These vascular lesions often present with pericallosal intracerebral hematoma. Surgical approaches to these aneurysms are associated with a high complication rate. Successful management is possible in our low-resource neurosurgical facility.
Introduction Pericallosal artery aneurysms are rare. Very few cases of this vascular anomaly have been published from West Africa. We report the first case of a ruptured pericallosal artery (PCA) aneurysm managed in a Nigerian neurosurgical facility, with the aim to add to the limited documentation on vascular brain lesions in our sub-region. The management outcome of the index patient and a literature review on these unusual aneurysms were also discussed. Case report A middle-aged known hypertensive woman who presented with clinical features of a WFNS grade I subarachnoid hemorrhage (SAH). A plain cranial computerized tomography (CT) scan revealed SAH, a supracallosal intracerebral hematoma and intraventricular hemorrhage. Cranial computerized tomography angiography (CTA) showed a small right pericallosal artery aneurysm, which was treated (with clipping via an interhemispheric approach) in a resource-constrained neurosurgical facility. The patient has remained well over a six-year follow-up period. Discussion PCA aneurysms have a high tendency to bleed compared with other supratentorial intracranial aneurysms in spite of their small size. Microsurgical approach, although difficult, is an effective treatment option for these rare aneurysms. Conclusion Surgical clipping remains a safe and useful treatment option for pericallosal artery aneurysms in a low-resource neurosurgical facility.
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Husain S, Andhitara Y, Jena SP, Padilla J, Aritonang S, Letsoin I. Endovascular Management of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms: A Retrospective Review Study. World Neurosurg 2017; 107:588-596. [PMID: 28823655 DOI: 10.1016/j.wneu.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience. METHODS A retrospective review of 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in the Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We report the clinical presentations, cerebral angiographic findings, endovascular treatment, complications, and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and the Raymond scale, respectively. RESULTS Of 11 patients, 54.5% were female and 45.5% were male; the mean age was 48.4 years (range, 33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All the DACA aneurysms were small. Postcoiling angiograms showed complete occlusion in 9 patients. Two patients had intraprocedural aneurysm rupture but without any clinical sequelae, and 1 patient had thrombus formation, which was thrombolysed at the end of coiling. All patients had good outcomes. CONCLUSIONS Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.
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Affiliation(s)
- Shakir Husain
- Department of Interventional Neurology and Stroke, Institute of Neurosciences, Max Super-Specialty Hospital, Saket, New Delhi, India; Interventional Neurology and Stroke Fellowship Program, Neo Hospital, Noida, India.
| | - Yovita Andhitara
- Department of Neurology, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Somnath Prasad Jena
- Interventional Neurology and Stroke, Stroke and Neurointervention Foundation, Max Super-Specialty Hospital, Saket, New Delhi, India
| | - Jorge Padilla
- Neurology, Cotabato Regional and Medical Center, Cotabato City, Philippines
| | - Sahat Aritonang
- Department of Neurology, Tangerang General Hospital Indonesia, Interventional Neurology and Stroke, Saket City Hospital, New Delhi, India
| | - Igor Letsoin
- Department of Neurology, Jayapura General Hospital/Cendrawasih University, Jayapura, Indonesia
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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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