Internal Carotid Artery Aneurysm Research Articles

Hemodynamic study of the ICA aneurysm evolution to attain the cerebral aneurysm rupture risk

The influence of the aneurysm evolution on the hemodynamic characteristic of the blood flow inside the sac region is comprehensively investigated. By using the computational method, the blood flow through the vessel and aneurysm of the sac region is examined to find the role of aneurysm evolution on the wall shear stress, pressure, and risk of aneurysm rupture. Three different models of ICA aneurysms are chosen for the investigation of the aneurysm evolution at risk of rupture. Obtained data shows that the evolution of the aneurysm decreases the wall shear stress and pressure on the sac surface while an oscillatory index of blood increases on the aneurysm wall.

Safety and efficacy of the novel Alpha stent for the treatment of intracranial wide-necked aneurysm

The Alpha stent is an intracranial closed-cell stent with a unique mesh design to enhance wall apposition. It recently underwent structural modifications to facilitate easier stent deployment. This study aimed to evaluate the safety and efficacy of stent-assisted coil embolization for unruptured intracranial aneurysms using the Alpha stent. Between January 2021 and November 2021, 35 adult patients with 35 unruptured intracranial aneurysms in the distal internal carotid artery were prospectively enrolled. For efficacy outcomes, magnetic resonance angiography at the 6-month follow-up was evaluated using the Raymond-Roy occlusion classification (RROC). The safety outcome evaluated the occurrence of symptomatic procedure-related neurological complications up to 6 months postoperatively. Technical success was achieved in 34/35 (97.1%). Six months postoperatively, aneurysm occlusion showed RROC I in 32/35 (91.4%) and RROC II in 3/35 (8.6%) patients. Procedure-related neurologic complications occurred in one patient (2.9%) who experienced hemiparesis due to acute lacunar infarction, which resulted in a 6-month mRS score of 1. The Alpha stent demonstrated excellent efficacy and safety outcomes in stent-assisted coil embolization of unruptured distal ICA aneurysms. The recent structural modifications allowed for easier stent delivery and deployment.Clinical trial registration number: KCT0005841; registration date: 28/01/2021.

Extracranial Carotid Artery Aneurysm: An Institutuinal Review

Abstract Background: Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA. Materials and Methods: A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected. Results: A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment. Conclusion: ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.

Ophthalmic segment internal carotid artery aneurysms endovascular treatment

Aim. To estimate the nearest and distant angiographic results of endovascular occlusion of aneurysms of the internal carotid artery ophthalmic segment using non‑reconstructive treatment methods.Materials and methods. The results of endovascular treatment of 75 patients with aneurysms of the ophthalmic segment of the internal carotid artery admitted to the Neurosurgical Department No. 3 of the V. L. Polenov Russian Research Neurosurgical Institute, from January 1, 2013 to December 31, 2016 were analyzed.Results. Of 75 aneurysms, 52 (69.3 %) were radically occluded from the blood flow (Type A) and 23 (30.7 %) were sub‑totally (Type B). When isolated occlusion with detachable coils was used, radical result was achieved in 13 (59.1 %) out of 22 cases, subtotal occlusion – in 9 (40.9 %). During balloon‑assisted occlusion 39 (73.6 %) out of 53 aneurysms were shut off from the blood flow totally, 14 (26.4 %) – sub‑totally. Partial aneurysm occlusion (Type C) was not achieved in any of the observations. Recurrence was observed in 3 (30 %) out of 10 cases on control angiography after isolated occlusion with detached spirals, and 2 (20 %) required repeated surgical intervention. From 38 aneurysms operated on using balloon‑assistence, 9 (23,7 %) recurred on control angiography, 6 of them (15,8 %) required repeated surgical intervention.Conclusion. Nonconstructive surgical interventions for occlusion of aneurysms of the internal carotid artery ophthalmic segment are still urgent and effective method of treatment of patients in acute period of aneurysm rupture combined with somatic status; however, they are inferior to reconstructive surgeries concerning radica lity in the long‑term period.

Incidentaloma: cephaleas revealing partial thrombosis of internal carotid artery aneurysm during a 30- week pregnancy of amenorrhea: a case report

Abnormal dilatation of the wall of an intracranial artery under the influence of various factors results in what we call a cerebral aneurysm. This creates a pocket where blood accumulates, as it communicates with the vessel via a collar.1 When an aneurysm has not yet ruptured, it is usually detected incidentally, but sudden onset of headache should prompt a search for an intracranial vascular cause.2 In this work, we report a case of a patient who presented with sudden onset of headache which revealed partial thrombosis of an aneurysm of the internal carotid artery during a pregnancy presumed to be at 30 days' gestation + 5 days in severe preeclampsia.

703 Identifying Unruptured Cavernous Internal Carotid Artery Aneurysms Growth and Rupture Over Time

INTRODUCTION: Aneurysms in the Cavernous Segment of the Internal Carotid Artery (ICA) often present in an indolent fashion with limited morbidity. However, their growth progression and possible rupture over time remains poorly defined, thereby limiting optimization of serial follow-up. METHODS: We identified a retrospective cohort of 179 patients with cavernous ICA aneurysms. Patient demographic data, possible risk factors, presenting symptoms, radiographic features of aneurysms, size progression, rupture status, and concomitant non-cavernous aneurysm rupture data were manually extracted. RESULTS: 179 patients (mean age at diagnosis 57.2 ± 15.9 years; 86.0% Female) had total 198 cavernous aneurysms. 44.4% of patients had no concomitant non-cavernous aneurysms, 41.9% had 1, and 13.6% had 2. No cavernous aneurysms ruptured during clinical follow-up. 17 non-cavernous concomitant aneurysm ruptured during follow up. 91.5% of cavernous aneurysms showed no change in size, 4.2% increased in size, and 4.2% were initially treated at time of diagnosis. Of the cavernous aneurysms that increased in size, there was a mean increase of 0.97 ± 0.4 mm and 1.1 mm ± 0.7 mm in long and short axis diameter across 5.2 ± 2.3 years. Weakness as a presenting symptom was the only predictor of cavernous aneurysm growth (p-value 0.022). Number of concomitant non-cavernous aneurysms (p-value 0.007) and sub-arachnoid hemorrhage (SAH) as a presenting symptom (p-value <0.0001) were associated with concomitant non-cavernous aneurysmal rupture. CONCLUSIONS: Cavernous ICA aneurysms demonstrate no rupture and limited growth over years of clinical follow-up. No patient radiographic or risk factor suggests increased risk of rupture or other symptomology, thus except for select individuals with concomitant non-cavernous aneurysms and SAH on presentation, there is likely limited clinical benefits in serially following these aneurysms over time.

The Influence of Embolization of Internal Carotid Artery Aneurysms on Arterial Tortuosity: A Prospective Cohort Study

PurposeTo compare quantitative tortuosity descriptors of the internal carotid artery (ICA) after intracranial aneurysm embolization and to determine possible factors associated with its change. Materials and MethodsAn analysis of 52 patients with embolized intracranial aneurysms was performed. ICA tortuosity was assessed by digital subtraction angiograms obtained prior to the embolization and after the first follow-up examination. For each patient, tortuosity descriptors were calculated: relative length (RL), sum of angle metrics (SOAM), triangular index, product of angle distance (PAD), and inflection count metric (ICM). To represent changes in tortuosity for each descriptor, delta (Δ) value was defined as value of the descriptor prior to embolization minus value of the descriptor on follow-up examination. ResultsIn a median follow-up of 14 months, no statistically significant changes in tortuosity were observed on the nonembolized side. On the embolized side, SOAM (2.89 [SD ± 0.92] vs 2.38 [SD ± 0.94]; P < .001), PAD (5.01 [SD ± 1.83] vs 3.95 [SD ± 1.72]; P < .001), and ICM (12.18 [SD ± 4.55] vs 9.76 [SD ± 4.04]; P = .006) were significantly higher after embolization than before embolization. Median ΔRL (−0.02 [−0.045 to 0.002] vs −0.01 [−0.02 to 0.003]; P = .003), ΔPAD (0.84 [0.30–1.82] vs 0.10 [−0.001 to 1.10]; P < .001), and ΔICM (2.05 [0.42–3.50] vs 0.27 [0.02–2.16]; P = .004) were significantly higher on the embolized side. Tortuosity correlated with elapsed time after embolization. ConclusionsTortuosity of the ipsilateral ICA increased after intracranial aneurysm embolization.

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note.

Surgery is effective for extracranial internal carotid artery (EICA) aneurysms. However, the risk of cranial nerve injury associated with surgical repair, such as graft-assisted resection and extracranial-intracranial bypass techniques, is relatively high. Here, we report two cases of surgical treatment for EICA aneurysms and describe the surgical techniques and strategies to avoid cranial nerve injury. Two patients presented to our facility with an increasing cervical pulsatile mass and no neurological symptoms. Angiography showed a large aneurysm in the cervical internal carotid artery. Surgical treatment was performed to prevent rupture of the aneurysm. In both patients, the aneurysm was strongly attached to the vagus nerve. The aneurysm and vagus nerve were carefully dissected using a low-power bipolar (20 Malis; 3 watts), leaving connective tissue on the vagus nerve side. The aneurysm was detached from the vagus nerve without injury. Based on intraoperative findings, one patient underwent clipping, and the other underwent aneurysmectomy and primary closure for aneurysm obliteration and angioplasty. Both patients were discharged without any cranial nerve dysfunction. The selection of a strategy based on intraoperative findings and low-power bipolar cutting is important for the treatment of extracranial carotid artery aneurysms to preserve cranial nerves.

A Case of Posterior Communicating Artery Aneurysm Combined With an Atypical Origin of the Ipsilateral Ophthalmic Artery

Objective: Anatomy of the ophthalmic artery (OA) is of great practical importance in surgery for anterior circulation aneurysms. In most cases, the OA arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal inferolaterally to the optic nerve. The OA arising from the anterior cerebral artery (ACA) and entering the optic canal above the optic nerve is extremely rare.Clinical case: We report a case of a 29-year-old female patient admitted to Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a ruptured true aneurysm of the left posterior communicating artery (PCoA) and an abnormal origin of the OA from the ACA. The disease manifested itself as ischemic stroke in the basal ganglia on the left causing diagnostic difficulties during initial hospitalization. Cerebral angiography confirmed a PCoA aneurysm and origin of the OA from the ipsilateral ACA. During surgery the neck of the aneurysm was clipped, and the aneurysm dome was opened to control the extent of clipping and remove thrombotic masses. During their removal, hemorrhage appeared from the posterior pole of the aneurysm. During the exploration it was found that the aneurysm was a dilated PCoA connecting the right ICA with the right posterior cerebral artery (PCA). A thrombosed anterior thalamoperforating artery emerged from the superior surface of the dome, and its junction with the precommunicating segment of the right PCA was detected in the region of the posterior pole of the aneurysm. The second clip was placed at the communication site between the aneurysm and the right PCA. The patient was discharged in satisfactory condition with a stable neurological status.Conclusions: The combination of abnormal anatomy of arteries at the base of the brain and cerebral aneurysms increases the risk of tactical errors and perioperative complications. Each such case requires a careful comparison of the clinical, imaging, and intraoperative findings. In the presented case of the patient with the ruptured rare PCoA aneurysm, the disease manifested atypically due to the partial thrombosis of the aneurysm and hemorrhage into the aneurysmal wall. The imaging findings revealed lacunar stroke in the thalamoperforating artery basin and an ICA aneurysm with no signs of subarachnoid hemorrhage. During the surgery the aneurysm was initially regarded as typical saccular. The opening of the dome and removal of all thrombotic masses made it possible to determine the eccentric fusiform nature of the aneurysm, perform its radical exclusion, and prevent fatal hemorrhage in the postoperative period.

Capabilities of Dynamic Magnetic Resonance Angiography in Patients With Cerebral Aneurysms in the Postoperative Period

Introduction: The leading cause of hemorrhagic stroke is a ruptured cerebral aneurysm (CA), accounting for 70%-85% of nontraumatic subarachnoid hemorrhages. The primary goals of CA treatment are to prevent a rupture, thrombosis, or symptoms of mass effect. The main treatment options for intracranial aneurysms are open clipping, flow-diverter device implantation, resection and stenting of aneurysms. Treated aneurysms should be monitored to assess the stability of the occlusion because more than 20% of surgically treated aneurysms are known to recur. Magnetic resonance angiography (MRA) has recently become increasingly attractive for the follow-up of surgically treated CAs because it is noninvasive, does not require hospitalization, and reduces complications associated with the frequent use of cerebral angiography.Objective: To evaluate capabilities of dynamic MRA in postoperative monitoring of patients with CAs.Materials and methods: The study was conducted at the premises of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). In a hospital setting, 38 patients with CAs were examined in the late postoperative period. All the patients underwent magnetic resonance imaging, 3-dimensional time-of-flight (3D-TOF) MRA, and dynamic MRA followed by cerebral angiography. Imaging findings (MRA, dynamic MRA, and cerebral angiography) were evaluated by radiologists, x-ray surgeons, and neurosurgeons. They assessed treated aneurysms according to the Raymond-Roy occlusion classification: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3). Untreated aneurysms in patients with multiple CAs and de novo aneurysms were also assessed, and we looked for other vascular malformations.Results: The study was conducted in the late postoperative period from 6 to 18 months. A total of 38 patients participated in the study; of them 27 were women (age, 32-77 years) and 11 were men (age, 32-65 years). Dynamic MRA detected neck remnants of 4 clipped aneurysms and 2 embolized ones, which was confirmed by cerebral angiography. According to the dynamic MRA results, in case of clipped aneurysms neck remnants were found in the anterior communicating artery (n = 2), internal carotid artery (n = 1), and anterior choroidal artery (n = 1). In case of embolized aneurysms, neck remnants were revealed in the internal carotid artery (n = 1) and basilar artery (n = 1). Dynamic MRA also detected 5 additional aneurysms: 2 internal carotid artery aneurysms, 1 basilar artery aneurysm, 1 anterior cerebral artery aneurysm, and 1 anterior communicating artery aneurysm. These findings coincided with those of cerebral angiography. Based on the results of our study, the sensitivity and specificity of dynamic MRA in detecting CA neck remnants and untreated aneurysms were 100%.Discussion: Dynamic MRA findings are fully consistent with those of cerebral angiography in terms of determining an aneurysm occlusion status during postoperative follow-up. As for evaluation of de novo intracranial aneurysms, dynamic MRA is also superior to noncontrast 3D-TOF MRA in assessment of aneurysm shape and neck detection. Therefore, dynamic MRA can clearly visualize the structure of cerebral vessels mainly due to the effect of blood flow and static tissue contrast, and the principle is mainly the effect of multiphase scanning and accumulation of contrast agent.Conclusions: Dynamic MRA has a number of advantages over cerebral angiography, such as noninvasiveness, high-resolution images of the cerebral arteries, absence of radiation exposure, use of iodinated contrast agent, and absence of artifacts from metal clips or embolic material.

Anesthetic management of a patient posted for ruptured aneurysm repair with asymptomatic atrial myxoma

Abstract Atrial myxomas are rare cardiac tumors. It has to be surgically resected early when diagnosed, due to possible complications such as intracardiac obstruction, embolus, and metastasis. It becomes more challenging when found as an incidental finding in routine evaluation for a case of a ruptured aneurysm. Atrial myxoma is a common cause of ischemic and hemorrhagic strokes, but in 10%–15% of cases, it is associated with the development of metastatic intracranial aneurysms which is a rare complication of myxomatous emboli. We report the case of a 42-year-old female patient presented with subarachnoid hemorrhage, posted for the repair of left paraclinoid internal carotid artery aneurysm under general anesthesia with left interatrial septum myxoma.

Abstract TP8: Gender Differences in Intracranial Aneurysms

Background: Some studies have shown that females had a poorer prognosis after endovascular treatment for ruptured intracranial aneurysm than males. However, data has been sparse regarding differences in the periprocedural and perioperative complication rates with ruptured and unruptured intracranial aneurysms. Methods: This retrospective cohort study used data from the Stroke Thrombectomy and Aneurysm Registry, a database of 9 institutions in the United States, Europe, and Asia. The study presented intracranial aneurysms after microsurgical and/or endovascular treatment from January 1, 2013 to December 31, 2022. The primary outcome was the incidence of periprocedural cerebral infarction. Secondary outcomes were periprocedural intracranial hemorrhage, periprocedural mortality, perioperative vasospasm, and functional outcome at 90 days after the procedure. Results: Among 3342 aneurysm patients, 2447 were female and 857 were male, mean age in females and male were 59.6 and 57.1. Current smoker, family history of aneurysm, and ruptured aneurysm were observed in 23.5% vs 35.7 %, 10.8 % vs 5.7%, and 28.2% vs 40.5% of female and male patients, respectively. In female patients, internal carotid artery aneurysms were more commonly observed (31.1% vs 17.3%), however, anterior cerebral artery aneurysm were less commonly observed (18.5% vs 33.8%) compared to male patients. Periprocedural cerebral infarction rate was lower in females than males (2.4% vs. 4.4%; P = 0.002). The adjusted odds ratio of primary outcome of female to male was 0.72 (95% CI, 0.46 - 1.12). Incidence of periprocedural Intracranial hemorrhage and periprocedural mortality, perioperative symptomatic vasospasm, and functional outcome were similar in both groups. In this analysis, periprocedural cerebral infarction due to microsurgical treatment occurred frequently in the male patients, while incidence in endovascular treatment was similar in both groups (interaction P = 0.005). Conclusions: This large multicenter registry of patients undergoing intracranial aneurysm treatment found that female patients were not at increased risk of perioperative complications.

Abstract WP181: Treatment of Unruptured Small and Medium Wide-Necked Aneurysms of the Internal Carotid Artery Using the 64-Wire Surpass Evolve: Results of the SEASE International Registry

Introduction: The management of wide-necked internal carotid artery (ICA) aneurysms is technically challenging with established endovascular and microsurgical techniques that are limited by the associated morbidity and/or recurrence. The PREMIER study first demonstrated high rates of complete occlusion without parent vessel stenosis or permanent neurological complications after the treatment of wide-necked small and medium-sized intracranial ICA aneurysms with the 48-wire pipeline. We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve (SE) flow diverter for the treatment of the same intracranial ICA aneurysm population. Methods: This is a sub-analysis from the Safety and Effectiveness Assessment of the Surpass Evolve (SEASE) registry, an observational cohort study including 15 academic institutions in North America and Europe spanning between 2020-2023. Analysis included patients with unruptured wide-necked saccular aneurysms (not previously treated), measuring &lt;12 mm along the ICA segments. Primary effectiveness was complete occlusion (Raymond Roy Class 1) without retreatment at 1-year follow-up (core lab adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. Results: 129 cases were included (median age 58 years, IQR: 50-67 years, 85% females). Median aneurysm and neck size were 5.8 mm (IQR: 4.0-7.5) and 4.1 (IQR, 3.0-5.5). Most aneurysms were in the ICA C6 segment (66.7%, 86/129), followed by the C7 segment (21.0%, 21/129). Successful implantation was encountered in 99% (128/129) of the cases. At a median 10.1 months (IQR: 6.3-12.6), the rate of complete occlusion was 75.2% (91/121), ≥50% in-stent stenosis 7% (9/129), and retreatment 0.8% (1/129). Major stroke and overall mortality were reported in 1.6% (2/129) of the cases. Conclusion: Our study evaluating outcomes from the SEASE international multicenter registry found that patients with wide-necked unruptured saccular small to medium-sized aneurysms can be effectively treated with the 64-wire chrome-cobalt SE. Furthermore, the SE showed a considerable safety profile for this patient population.

Abstract TP151: Usefulness of 3D I-Flow Application in Predicting the Outcome of Flow Diverter Stenting for Large or Giant Carotid Aneurysms

Background and Purpose: The flow diverter (FD) has dramatically improved the treatment outcome of large / giant internal carotid artery (IC) aneurysms. However, it is difficult to predict the treatment outcome of FD just after the treatment. 3D iFlow is a novel application of 4D-digital subtraction angiography (4D-DSA) that can evaluate the arrival time of contrast media in 3D images, but its usefulness for neurointervention is unclear. Therefore, the aim of this study was to elucidate the utility of 3D iFlow in predicting the outcome of FD treatment for large / giant IC aneurysms. Methods: A total of 8 cases of large / giant aneurysms at IC cavernous portion treated with FD and were enrolled in this study. 3D iFlow images before and after placement of FD were acquired in all cases. Treatment outcome was evaluated by O’Kelly-Marotta(OKM) Grading Scale with DSA 6 months after treatment. The regions of interests (ROI) were set in IC bifurcation and petrous segment with 3D iFlow application, and the 3D iFlow transit time was measured by comparing the peak contrast intensities in 2 ROIs. We investigated the rate of changes in 3D iFlow transit time before and after the placement of FD. Results: FD was deployed successfully in all cases without coils. The number of OKM grade B, C and D with DSA 6 months after treatment were 2, 3 and 3 cases, respectively. The rate of changes in 3D iFlow transit time was significantly shorter in OKM grade D cases compared with grade B and C (52.5% vs 84.7%, p=0.03). Conclusion: 3D iFlow application may be effective to predict the treatment outcome of FD.

757 - Internal carotid artery aneurysms complicating lemierre syndrome-a case review

757 - Internal carotid artery aneurysms complicating lemierre syndrome-a case review

Retraction: Giant Unruptured Internal Carotid Artery Aneurysm.

[This retracts the article DOI: 10.7759/cureus.20423.].

Comparison of a covered stent and pipeline embolization device in intracranial aneurysm: a propensity score matching analysis

BackgroundThe Willis covered stent (WCS) and pipeline embolization device (PED) have partly overlapping therapeutic indications. However, the differences of effect between these two treatments remain unclear.ObjectiveTo compare clinical outcome, angiographic...

Hemodynamic effects of the blood flow on aneurysm rupture risk: Geometrical aspects

This study provides comprehensive information about the impact of the parent vessel’s shape on the risk of cerebral aneurysm rupture. It focuses on internal carotid artery (ICA) aneurysms with varying parent vessel sizes, analyzing different aspects of blood flow dynamics. By comparing various hemodynamic factors such as wall shear stress (WSS), oscillatory shear index (OSI) and pressure distribution, the researchers aim to establish a meaningful relationship between the parent vessel’s mean diameter and these significant hemodynamic parameters.

Recurrence of an extracranial internal carotid artery aneurysm treated with STA-MCA bypass and trapping due to neovascularization from an ascending pharyngeal artery: illustrative case.

Extracranial internal carotid artery aneurysms (EICAs) are rare. Although a high mortality risk has been reported in nonoperated cases, the optimal treatment for EICAs remains unknown. A 79-year-old female presented with painless swelling in the right neck. Imaging revealed a giant EICA with a maximum diameter of 3.2 cm. Superficial temporal artery-middle cerebral artery bypass and internal carotid artery (ICA) trapping were performed. Because the distal aneurysm edge was at the C1 level, the distal portion of the aneurysm was occluded by endovascular coiling, and the proximal portion was surgically ligated. Blood flow into the aneurysm disappeared after the operation. Three years postsurgery, enlargement of the aneurysm with blood flow from the ascending pharyngeal artery (APA) was detected. The EICA was resected after coiling the APA and ligating both ends of the aneurysm. Pathologically, neovascularization within the aneurysm wall was observed. Even if blood flow into an EICA disappears after ICA trapping, the EICAs can enlarge due to neovascularization from the neighboring artery. From the outset, removal of the aneurysm should be considered as a radical treatment strategy for giant EICAs.

Sexual Dysfunction after Clipping of Ruptured Intracranial Aneurysms.

Sexual dysfunction significantly affects interpersonal relationships and overall quality of life. It remains a matter of concern for risk assessment and counseling in patients with ruptured intracranial aneurysms. To assess the sexual dysfunctions in patients undergoing clipping for ruptured intracranial aneurysms and comparative evaluation among different anterior circulation aneurysms. We prospectively included 40 male patients of ruptured intracranial aneurysms of anterior circulation (age range: 20-60 years; sexually active preoperatively), managed with craniotomy and clipping. We evaluated the sexual outcome in patients with excellent Glasgow outcome score (GOS) five at a minimum one year of follow-up. Patients with GOS-5 status at follow-up were broadly classified into two groups: Anterior communicating artery aneurysm (Acom), and non-Acom) aneurysms. We valued sexual outcome with Subjective Sexual Arousal Scale for Men at follow-up, and compared in the two groups. Mean age of patients was 44.78 ± 9.51 years. Besides 20 Acom aneurysms, other groups included 11 middle cerebral artery aneurysms, five internal carotid artery aneurysms, three posterior communicating artery aneurysms, and one distal anterior cerebral artery aneurysm. The mean follow-up was 24.45 ± 13.58 months. Patients with non-Acom aneurysms had an overall better outcome in the sexual performance domain "P = 0.015," mental satisfaction domain "P = 0.009," and sexual assertiveness domain "P = 0.007." However, there was no statistical difference in partner communication domain "P = 0.593," and partner relationship domain "P = 0.378." Overall, the sexual outcome was inferior in patients treated for Acom aneurysms compared to other anterior circulation aneurysms. In cases of aneurysmal subarachnoid hemorrhage, sexual dysfunctions are common even after good clinical outcomes. The study revealed prominent differences in outcomes on the sexual quality of life in patients harboring Acom aneurysms as compared to anterior circulation aneurysms located off-midline.