MANAGEMENT OF DISTAL ANTERIOR CEREBRAL ARTERY ANEURYSMS

Abstract

Our goal was to assess the clinical and angiographic outcomes among patients undergoing treatment for distal anterior cerebral artery aneurysms at the Jefferson Hospital for Neuroscience (1997-2005). Forty-one patients (1.5% of all aneurysms treated) with distal anterior cerebral artery aneurysms had undergone treatment. The clinical and angiographic outcomes of these patients were studied retrospectively using chart reviews, operative reports, and angiographic reports. The mean clinical and angiographic follow-up periods were 16 months (range, 3-74 mo) and 16.5 months (range, 6-81 mo), respectively. Twenty-eight (68%) patients had undergone endovascular embolization (22 women, six men; mean age, 58.2 yr), whereas 13 (32%) had undergone microsurgery for clip ligation (six men, seven women; mean age, 47.4 yr). Within the coiled group, 50% of the patients belonged in the Hunt and Hess (HH) III and IV groups, whereas 46.2% of the patients in the clipped group were elective patients (HH Grade 0). The mean aneurysmal sizes among the clipped and coiled groups were 4.9 and 5.5 mm, respectively. Among the clipped patient population, 100% of the patients had successful clip ligation as evidenced by intraoperative cerebral angiography, there was a 0% recurrence rate among the two patients who have had long-term follow-up, 0% recurrent subarachnoid hemorrhage, and 92% patients achieved a modified Glasgow Outcome Scale score of I to II. Among the coiled patient population, there was an 89% rate of successful embolization, 18% recurrence rate, 0% recurrent subarachnoid hemorrhage, and 64% achieved a modified Glasgow Outcome Scale score of I to II. None of the patients had clinically symptomatic vasospasm. A strong correlation existed between having a ventriculostomy and requiring a shunt in patients with HH Grade IV compared with patients in HH Grades I through III. In our analysis, clinical outcomes were better in the clipped group; however, the differences are not statistically significant (P = 0.3675) and are explained by the selection bias. Statistically significant predictors of outcomes were age (<60 yr), size of the aneurysm (>5 mm), absence of ventriculostomy, and presenting HH grade.