Pericallosal artery aneurysm - Case report, literature review and management outcome

Presentation, management and outcomes of ruptured intracranial aneurysms in Africa: A systematic review and meta-analysis

BACKGROUND

Approximately two percent of the world's population are affected by intracranial aneurysms (IAs). This study aimed to evaluate literature regarding presentation, treatment and outcomes of ruptured IAs in Africa.

METHODS

A systematic review of the literature using PubMed/MEDLINE, SCOPUS, Web of Science and Google Scholar databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Twenty-one retrospective studies with 1,109 patients and 11 case reports (10 countries) were included. The mean Methodological Index for Nonrandomized Studies (MINORS) for included articles was 9.1 ± 2.5. The mean age was 43.3 years (95 %CI: 37.8-48.8), with 58.4 % (342/586) female patients. WFNS/H&H grade 1 was reported in 41.2 % (98/238) of cases and Fischer grade 2 was reported in 30.4 % (98/322) of cases. CT angiography was utilized in 94.6 % (560/592, 12 articles). The ICA was reported in 24.5 % of cases (CI: 12.9 %-36.1 %). AComA and MCA were affected in 21.2 % (95 %CI: 15.2-27.2 %) and 21.3 % (95 %CI: 15.2-27.2 %) of cases, respectively. The odds of ruptured aneurysms in the anterior circulation were 14.3 (CI: 6.3-32.2). Surgical clipping was reported in 75.0 % (448/597) and coiling in 20.4 % (122/597) across 13 studies. 66.8 % (95 %CI: 57.4-76.3 %) of patients experienced neurological improvement with a mortality rate of 12.3 % (95 %CI: 7.5-17.1 %) at last follow-up.

CONCLUSION

Ruptured IAs are small and located in the anterior circulation. The lack of detailed aneurysm size reporting hampers the identification of a critical rupture size for management. More research is needed to understand aneurysm characteristics and predictors of rupture in Africa.

Open Microsurgical Versus Endovascular Management of Unruptured and Ruptured Brain Aneurysms

Open microsurgical and endovascular techniques are the 2 primary strategies for treating intracranial aneurysms. Microsurgical clipping and adjuvant technical maneuvers are well-established techniques with a track record for high occlusion rates and durable repairs. Endovascular, endosaccular, and extrasaccular therapies are associated with lower peri-procedural morbidity but with generally higher rates of retreatment. We discuss key clinical and anatomic considerations in treatment decision-making and compare the risks and benefits of microsurgical vs endovascular treatment within each context.

Mirror Aneurysms of the Pericallosal Artery Clipped During a Single Surgical Procedure: Case Report and Literature Review

Pericallosal artery aneurysms are rare, accounting for 2-9% of all intracranial aneurysms, and mirror aneurysms in this location are exceptionally uncommon, presenting unique surgical challenges due to their deep location and proximity to critical neurovascular structures. The aim of this case report is to describe the surgical management and successful outcome of a patient with mirror pericallosal artery aneurysms and to contribute insights into the clinical and surgical considerations for this rare condition. We report the case of a 71-year-old female with multiple cardiovascular and metabolic conditions, including hypertension and smoking-well-established risk factors for intracranial aneurysm formation and rupture. She presented with a Hunt and Hess grade II subarachnoid hemorrhage resulting in communicating internal hydrocephalus. Preoperative angiography revealed mirror aneurysms of the pericallosal artery. The patient underwent a left basal paramedian frontal craniotomy, during which a ruptured aneurysm on the right A2 segment and an unruptured aneurysm on the left A2 segment were identified. Both aneurysms were successfully clipped using curved Yasargil clips. Postoperative recovery was favorable, with no neurological deficits and stable imaging findings at a three-month follow-up. This case underscores the necessity for precise microsurgical intervention and a thorough understanding of pericallosal artery anatomy to manage such rare and challenging conditions effectively. The role of hyperlipidemia and statin use in intracranial aneurysm development remains debated and warrants further investigation. Our successful management of mirror pericallosal artery aneurysms contributes to the limited literature on this rare condition and highlights the importance of meticulous surgical techniques for favorable outcomes.

The Epidemiological Burden of Neurovascular Pathology in Nigeria: A Systematic Review and Pooled Patient-Level Analysis

OBJECTIVE

Vascular neurosurgery has developed significantly in Nigeria, but its burden and challenges remain unclear. This study systematically reviewed vascular neurosurgical literature from Nigeria.

METHODS

Four research databases and gray literature sources were searched from 1962-2021. ROBINS-I tool was used to assess risk of bias. Descriptive, narrative, and statistical analyses were conducted on all variables. Where appropriate, paired t-tests and Chi-squared independence tests were used (α = 0.05).

RESULTS

56 articles were included and 3203 patients pooled for analysis. Risk of bias was moderate-high. Most articles were published over the last 20 years with retrospective cohort studies and case reports being the most common study designs. The cohort had a relatively even gender split and an average age of 49 years (±22). Cerebrovascular accidents accounted for over 85% of diagnoses, with most etiologies being traumatic. Headache and motor deficit were the most prevalent clinical features. X-ray and carotid angiography were the most commonly reported imaging modalities, closely followed by computed tomography (CT) and CT angiography. The top two radiological diagnoses were ischemic cerebrovascular disease and intracerebral hematoma. Aneurysmal clipping and hematoma evacuation were the most commonly reported treatment modalities. Outcome at last follow-up was favorable in 48%. The mortality rate was 6%. Post-treatment complications included chest infection and rebleeding.

CONCLUSIONS

This study illustrates the epidemiological burden of neurovascular pathology (based on the available data in published literature) in Nigeria, and raises awareness amongst service providers and researchers of the attendant challenges and epochal trends seen within vascular neurosurgery in Nigeria.

Current Treatment Management of Aneurysmal Subarachnoid Hemorrhage with Prevailing Trends and Results in Tanzania: A Single-Center Experience at Muhimbili Orthopedic and Neurosurgery Institute

BACKGROUND

In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain poorly understood, with many underdiagnosed cases. Muhimbili Orthopaedic and Neurosurgery Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim of this study is to describe the current aSAH management with regional outcomes and limitations.

METHODS

Patients with aSAH confirmed by computed tomography/magnetic resonance angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiologic characteristics, injury characteristics, and the modified Rankin Scale (mRS) score.

RESULTS

In total, 22 patients, with a female/male ratio of 1.4 and a median age of 54 years (interquartile range [IQR], 47.2-63 years) harboring 24 aneurysms were analyzed. Thirteen patients (59.1%) paid out of pocket. The median distance traveled by patients was 537 km (IQR, 34.7-635 km). The median time between admission and treatment was 12 days (IQR, 3.2-39 days). The most common symptoms were headache (n = 20; 90.9%) and high blood pressure (n = 10; 45.4%). Nine patients (40.9%) had Fisher grade 1 and 12 (54.5%) World Federation of Neurosurgical Societies grade I. The most common aneurysms were of the middle cerebral artery (7/29.2%). Fourteen patients (63.6%) underwent clipping; of those, only 4 (28.6%) were operated on within 72 hours. Mortality was 62.5% in the nonsurgical group. Among clipped patients, 78.6% showed favorable outcomes, with no mortality. Endovascular treatment is not available in Tanzania.

CONCLUSIONS

To our best knowledge, this is the first study highlighting aSAH management in Tanzania, with its assets and shortcomings. Our data show pertinent differences among international treatment guidelines, with the resultant outcomes, such as high preoperative mortality resulting from delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.

A case report of pericallosal aneurysm successfully treated with flow diverter stents

Pericallosal artery aneurysm (PAA) is a relatively uncommon type of intracranial aneurysm that tends to rupture more frequently and cause higher mortality rates than other types of cerebral aneurysms. Surgery to address PAA is difficult due to its deep-seated location, the size of the aneurysmal sac, and the limited surgical field. In recent years, with the development of percutaneous interventions, endovascular treatment has become the preferred, minimally invasive intervention method for the treatment of pericallosal aneurysms. In this article, we present a case of PAA that was successfully treated with flow diversion therapy in a 51-year-old male.