Pericallosal aneurysm: A difficult challenge for microsurgery and endovascular treatment

R Aboukaïs; F Zairi; P Bourgeois; F Boustia; X Leclerc; J-P Lejeune

doi:10.1016/j.neuchi.2015.03.010

Pericallosal aneurysm: A difficult challenge for microsurgery and endovascular treatment

Neurochirurgie. 2015 Aug;61(4):244-9. doi: 10.1016/j.neuchi.2015.03.010. Epub 2015 Jun 10.

Authors

R Aboukaïs¹, F Zairi², P Bourgeois², F Boustia³, X Leclerc³, J-P Lejeune²

Affiliations

¹ Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France. Electronic address: rabihdoc@hotmail.com.
² Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France.
³ Department of neuroradiology, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France.

PMID: 26072225
DOI: 10.1016/j.neuchi.2015.03.010

Abstract

Introduction: Pericallosal artery aneurysms (PAA) represent 2 to 9% of intracranial aneurysms and their management remains difficult.

Objective: We aimed to report our experience to evaluate the outcome of patients with ruptured and unruptured PAA, when the treatment modality is decided in a multidisciplinary fashion.

Materials and methods: In this retrospective study, we included 28 patients (8 men and 20 women) treated for a PAA in our institution between 2002 and 2012, among the 2430 patients who underwent the treatment of an intracranial aneurysm in the same period. Fifteen patients harbored a ruptured aneurysm while 13 benefited from a prophylactic treatment. The mean age at diagnosis was 52 years (range 37 to 75 SD: ± 5) in patients with ruptured aneurysm and 54.2 years (range 35 to 66 SD: ± 5) in patients with unruptured aneurysm. Endovascular treatment has been performed in 9 patients while 19 patients underwent a microsurgical treatment. Clinical outcome has been assessed using the modified Rankin scale (mRS) at 3 months. Long-term imaging follow-up included a CT angiography at 36 months for clipped aneurysms and MR angiography at 6, 18 and 36 months for coiled aneurysms.

Results: The median follow-up was 3.4 years (range 2.8 to 4.2). The mRS was ≤ 2 in all patients with unruptured aneurysms. In patients with ruptured aneurysm, the mRS was ≤ 2 at 3 months in 13 patients (87%). Persistent cognitive disorders were noted in 8 patients with ruptured aneurysm, 2 of them were considered as possibly related to the treatment. Aneurysm recurrence has been depicted in 4 patients (at 6 months in 3 patients and 1 year in 1 patient) requiring further treatment in all cases; all of them had an aneurysm remnant on immediate conventional angiography. No recurrence was noted in patients without remnant on immediate post-treatment angiography.

Conclusion: Both endovascular and microsurgical treatment are challenged in this location. Multidisciplinary discussion is essential to optimize the management of patients with PAA.

Keywords: Aneurysm; Anévrysme; Clippage; Clipping; Endovasculaire; Endovascular; Pericalleux; Pericallosa.

MeSH terms

Adult
Aged
Aneurysm, Ruptured / surgery*
Cerebral Angiography / methods
Embolization, Therapeutic / methods
Female
Humans
Intracranial Aneurysm / therapy*
Male
Microsurgery* / methods
Middle Aged
Retrospective Studies
Treatment Outcome