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Microsurgical and endovascular management of pericallosal aneurysms
  1. Ferdinand K Hui1,
  2. Albert J Schuette2,
  3. Shaye I Moskowitz1,
  4. Alejandro M Spiotta3,
  5. Michael L Lieber4,
  6. Peter A Rasmussen1,
  7. Jacques E Dion5,
  8. Daniel L Barrow2,
  9. C Michael Cawley2,5
  1. 1Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
  3. 3Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Department of Radiology, Emory University, USA
  1. Correspondence to Ferdinand K Hui, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA; huif{at}ccf.org

Abstract

Background Pericallosal, or A2 bifurcation, aneurysms are an infrequently encountered cause of subarachnoid hemorrhage (SAH). While the International Subarachnoid Aneurysm Trial showed improved outcomes for patients with any ruptured anterior circulation aneurysm treated with embolization, there was also a higher recurrence rate for embolized aneurysms. Notably, there were relatively few pericallosal aneurysms.

Objective Specific analysis of pericallosal aneurysms may help guide therapeutic decisions.

Methods Retrospective analysis of patients who presented with proven saccular pericallosal aneurysms was performed at two institutions from 1999 to 2009. Patients were stratified according to presentation Hunt and Hess grades and modified Fisher scores, treatment modality and outcomes as well as development of vasospasm, hydrocephalus and required treatment.

Results Eighty-eight patients with pericallosal aneurysms were identified. Sixty-two presented with SAH and 26 in elective fashion, 2 of whom had a prior history of SAH. Fifty-four patients underwent microsurgical repair and 32 endovascular repair. Patients presenting with SAH due to pericallosal aneurysm treated with an endovascular approach were more likely to have a good modified Rankin scale (mRS) (mRS 0–2 vs 3–6) (p=0.028), to make a complete recovery (mRS=0) (p=0.017) and were less likely to die (mRS=6) (p=0.026). Patients with electively treated pericallosal aneurysms did not have statistically significant differences in outcome between surgical and endovascular cohorts. Differences in secondary endpoints did not reach significance.

Conclusion Patients with ruptured pericallosal aneurysms fare better with endovascular therapy, with better chance of complete recovery. Surgical and endovascular treatments of unruptured pericallosal aneurysms have similar results and outcome.

  • Aneurysm
  • embolization
  • microsurgical repair
  • pericallosal aneurysm
  • subarachnoid hemorrhage

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Footnotes

  • Competing interests None.

  • Ethics approval The database was prospectively collected and approved by the IRB office of Cleveland Clinic and Emory University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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