Anterior Communicating Artery Aneurysms

Background Anterior communicating artery aneurysms together belong to the most common intracranial aneurysms. Despite further development and improvements in treatment modalities and intensive management of vasospasms, their treatment remains challenging. We reviewed our single institution results of the patients treated as inpatients.

Material and Methods We have retrospectively evaluated patients treated as inpatients in 2008–2012 at the Department of Neurosurgery, University Hospital Brno, Czech Republic. Outpatient patients were not included in this study. We focused on final outcome, surgical/endovascular treatment proportion, treatment complications, institution-based multidisciplinary decision making in selecting treatment strategy and modality.

Results Between 2008 and 2012, we have actively treated as inpatients 99 patients with anterior communicating artery aneurysm, 60 were men. Out of 99 patients, 90 patients had ruptured aneurysms, 9 were treated electively with unruptured aneurysm. Fifty-eight patients were treated surgically—57 by clipping, 1 by aneurysm wrapped, 25 patients received endovascular treatment including 4 patients with recoiling. There was no reclipping of aneurysm in our group. One patient was clipped because of failure of endovascular treatment. Sixteen patients did not reach the treatment as they were in poor condition. Out of 99 patients, 47 reached good recovery, 7 moderate disability, 11 severe disability, 9 were vegetative. Twenty-five patients died.

Conclusion Anterior communicating artery aneurysms still present as challenging ones to treat with good outcome. Despite our efforts, more than half of the patients had unfavorable outcome. Sensible indication and use of both modalities enable to treat these lesions adequately. Further improvements in intensive care treatment may help in fighting with deleterious delayed neurological deficit caused by secondary changes (vasospasms).