Pericallosal aneurysm: A difficult challenge for microsurgery and endovascular treatment

Abstract

IntroductionPericallosal artery aneurysms (PAA) represent 2 to 9% of intracranial aneurysms and their management remains difficult. ObjectiveWe 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 methodsIn 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. ResultsThe 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. ConclusionBoth endovascular and microsurgical treatment are challenged in this location. Multidisciplinary discussion is essential to optimize the management of patients with PAA.