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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
11:58

Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms

Published on: August 11, 2015

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Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms

Yushiro Take1, Tomoya Kamide1, Yuichiro Kikkawa1

  • 1Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.

Surgical Neurology International
|June 4, 2021
PubMed

Insights

Treatment for rare distal anterior cerebral artery (ACA) aneurysms yielded acceptable outcomes for 62.5% of patients. Both surgical clipping and coil embolization showed similar results, but poor neurological grade and hematomas indicated a worse prognosis.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Interventional Neuroradiology

Background:

  • Distal anterior cerebral artery (ACA) aneurysms are uncommon, accounting for 1-9% of all intracranial aneurysms.
  • Optimal treatment strategies for these aneurysms remain a subject of debate.
  • This study examines clinical features and treatment outcomes for ruptured distal ACA aneurysms at a single institute.

Purpose of the Study:

  • To clarify clinical features and treatment outcomes of ruptured distal ACA aneurysms.
  • To compare outcomes between surgical clipping and endovascular coiling.
  • To identify risk factors for poor outcomes in patients with distal ACA aneurysms.

Main Methods:

  • Retrospective review of 37 consecutive patients with ruptured distal ACA aneurysms treated between 2012 and 2018.
  • Comparison of clinical presentations, radiographic findings, and outcomes between surgical clipping and coil embolization groups.
  • Multiple regression analysis to identify risk factors for poor outcomes (modified Rankin Scale 4-6).

Main Results:

  • Surgical clipping was performed in 75.7% of patients, and coil embolization in 24.3%.
  • Higher complete occlusion rates were observed with surgical clipping (P < 0.01).
  • No significant differences in procedure-related morbidity and mortality between the two treatment groups were found.

Conclusions:

  • Acceptable neurological outcomes (mRS 0-3) were achieved in 62.5% of patients.
  • No significant differences in treatment results were observed between clipping and coiling.
  • World Federation Neurological Surgeons (WFNS) Grade IV-V and frontal lobe hematomas were identified as risk factors for poor prognosis.
Abstract

Keywords:
Coil embolizationPoor prognosisRuptured distal anterior cerebral aneurysmSurgical clippingTreatment outcome

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