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.
OBJECTIVE
To assess the influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results.


METHODS
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.


CONCLUSIONS
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.
Carvi y Nievas
Mario Nazareno
MN
Department of Neurosurgery, Städtische Kliniken Frankfurt am Main-Höchst, FFM-Höchst, Germany. mcnievas@t-online.de
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013525:Surgical Instruments; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome