Surgical treatment of distal cerebral aneurysms

Abstract

Background. Distal cerebral aneurysms are very rare. To date, there are very few publications on distal cerebral aneurysms and they are mostly limited to clinical case series.Aim. To analyze anatomical characteristics of distal cerebral aneurysms and surgical outcomes, as well as to identify risk factors for a poor outcome and develop a treatment algorithm on this basis; to determine the role of neuronavigation and revascularization in the surgical treatment of distal cerebral aneurysms.Materials and methods. We performed a retrospective analysis of surgical outcomes of 153 patients with distal cerebral aneurysms treated in N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow Healthcare Department) between January 1, 2000 and December 31, 2019.Results. Distal cerebral aneurysms were identified in 4.5 % cases of all cerebral aneurysms; 81.7 % of patients with distal cerebral aneurysms were admitted to the hospital with ruptured aneurysms. The most frequent locations of distal cerebral aneurysms were pericallosal and middle cerebral arteries. Distal cerebral aneurysms were usually small (77.5 %), had a wide neck (31.8 %), and fusiform structure (15.7 %). Aneurysm clipping was performed in 74.5 % cases; parent artery trapping, in 23.5 % of patients; revascularization, in 5.9 % of patients. The main risk factors for a poor outcome included aneurysm size and location, patient grade on the modified scale of the World Federation of Neurosurgical Societies (mWFNS), and presence of severe vasospasm.Conclusion. The developed surgical algorithm for distal cerebral aneurysms (based on the assessment of a poor outcome risk factors, the use of neuronavigation, arterial patency control, and revascularization) could improve surgical outcomes of patients with distal cerebral aneurysms.