Microsurgical and endovascular management of ruptured anterior communicating artery aneurysms: Single-center study

Document Type : Original Articles

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Neurosurgery department, Faculty of Medicine, Tanta University

Abstract

Background: Treatment of ruptured anterior communicating artery aneurysms is still challenging.
Aim: We report our experience with management of ruptured AcomA aneurysms, discussing factors controlling selection of management strategy and analyzing radiological and clinical outcomes.
Patients and methods: A retrospective analysis of 72 patients with ruptured AcomA aneurysms treated at our institute between July 2013 and July 2023. Patients were divided into two groups according to the treatment modality used: Group A, microsurgical clipping group, and Group B, endovascular coiling group.
Results: This study included 72 patients, 29 (40%) of them were micro-surgically clipped (Group A) and 43 (60%) were endovascularly coiled (Group B). At admission, intracerebral hematoma, intraventricular hemorrhage, and hydrocephalus were more predominant in group A. One patient experienced rebleeding 3 days after microsurgical clipping from an aneurysm remnant (reclipping was done with a fatal outcome).
Chronic hydrocephalus requiring permanent VP shunt occurred in 2 cases (7%) in Group A and 7 patients (16%) in Group B. Good recovery was reported in 22 patients (76%) in group A and 28 patients (65%) in group B.
Early postoperative CTA revealed complete aneurysm occlusion in (97%) of patients in Group A and (81%) in Group B. Stability of occlusion was reported at 100% in Group A and 80% in Group B.
Conclusions: Management of ruptured AcomA aneurysms is still challenging, but satisfactory outcome results can be achieved in centers with the availability of both endovascular coiling and microsurgical clipping facilities, besides adequate neuro-intensive care management and early rehabilitation.

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