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Management of Complex Cerebral Aneurysms

Lorenzo Pescatori1, Giovanni Grasso2, Maria Pia Tropeano3

  • 1Department of Human Neurosciences, Neurosurgery, University "Sapienza" of Rome, Rome, Italy.

World Neurosurgery
|March 8, 2022
PubMed

Insights

Endovascular treatment is the preferred approach for complex intracranial aneurysms (CIAs). Surgical clipping and revascularization are viable alternatives, with proper treatment selection ensuring favorable patient outcomes.

Area of Science:

  • Neurosurgery
  • Interventional Radiology
  • Vascular Neurology

Background:

  • Complex intracranial aneurysms (CIAs) present significant treatment challenges due to factors like size, prior treatments, location, poor collateral circulation, thrombosis, and calcification.
  • The primary goal in treating CIAs is to occlude the malformation from cerebral circulation, with both endovascular and surgical methods being effective options.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of different treatment modalities for complex intracranial aneurysms (CIAs).
  • To determine the optimal treatment strategy for CIAs based on patient presentation and aneurysm characteristics.

Main Methods:

  • A retrospective analysis of 170 complex intracranial aneurysms (CIAs) treated between 1990 and 2020.
  • Aneurysms were located in various intracranial segments, including the internal carotid artery (ICA), cavernous sinus, paraclinoid region, and posterior circulation.
  • Treatment decisions were made by a multidisciplinary team, prioritizing endovascular methods, followed by surgical clipping, and revascularization when necessary.

Main Results:

  • Out of 170 patients, 45 received endovascular treatment, 77 underwent surgical clipping, and 55 required revascularization procedures.
  • In the unruptured group, outcomes included 12 deaths, 22 major complications, 3 minor complications, and 101 uneventful courses.
  • In the ruptured group, outcomes included 9 deaths, 10 major complications, 1 minor complication, and 13 complete recoveries.

Conclusions:

  • Endovascular treatment is recommended as the primary therapeutic option for complex intracranial aneurysms (CIAs).
  • Direct surgical clipping and revascularization serve as important alternative treatments.
  • Accurate selection of the therapeutic approach is crucial for achieving positive clinical outcomes in CIA management.
Abstract

Keywords:
Cerebral aneurysmClippingEndovascularRupture

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