The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases
Introduction: Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture. Research question: To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysm...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000086 |
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| author | Roua Nasir Midhat e Zahra Naqvi Salaar Ahmed Maarij ul Hassan Rabeet Tariq Saad Akhter Khan Pia Koeskemeier Rajiv K. Khajuria Mohammad Hamza Bajwa Sajjad Muhammad |
| author_facet | Roua Nasir Midhat e Zahra Naqvi Salaar Ahmed Maarij ul Hassan Rabeet Tariq Saad Akhter Khan Pia Koeskemeier Rajiv K. Khajuria Mohammad Hamza Bajwa Sajjad Muhammad |
| author_sort | Roua Nasir |
| collection | DOAJ |
| description | Introduction: Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture. Research question: To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysms to inform decision-making. Materials and methods: Medline, Scopus, and Cochrane databases were searched for records examining cases diagnosed with giant AComm aneurysms. The study type, sample size, patient age, aneurysm site, aneurysm size, presenting complaints, and treatment modality were tabulated, and methodological quality was assessed. Additionally, two cases from our institution were included. Results: The data from 24 retrieved records, including 45 cases (60% treated with direct clipping/clip reconstruction, 20% with surgical bypass±trapping, and 16% with endovascular/combined methods) were obtained. The mean age was 52 years with an overall male preponderance (3:1). 73% presented with symptoms; mostly visual impairment/loss and subarachnoid hemorrhage. 82% had favorable outcomes (mRS 0–2). 56% had a mean maximum diameter between 25 and 30 mm. Cases treated by direct clipping/reconstruction were primarily ruptured, while cases treated by surgical bypass/trapping were unruptured or asymptomatic. Endovascular/combined methods were utilized for only few cases. Discussion and conclusion: Immediate suspicion is warranted for visual impairment with headaches in adults or seizures in the elderly. Direct clipping is the first-line treatment for ruptured cases closely followed by surgical bypass and trapping for unruptured cases. There is limited data on endovascular/combined methods. Evidence from case reports/series should be interpreted with caution. Both inter-modality and intra-modality nuances exist. |
| format | Article |
| id | doaj-art-e34e0e9ff6524ce6be56d21c576d5d41 |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-e34e0e9ff6524ce6be56d21c576d5d412025-02-06T05:13:04ZengElsevierBrain and Spine2772-52942025-01-015104189The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of casesRoua Nasir0Midhat e Zahra Naqvi1Salaar Ahmed2Maarij ul Hassan3Rabeet Tariq4Saad Akhter Khan5Pia Koeskemeier6Rajiv K. Khajuria7Mohammad Hamza Bajwa8Sajjad Muhammad9Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, PakistanDepartment of Neurosurgery, Liaquat National Hospital, Karachi, PakistanSection of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, PakistanZiauddin University, Karachi, PakistanSection of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, PakistanDepartment of Neurosurgery, Liaquat National Hospital, Karachi, PakistanDepartment of Neurosurgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, GermanyDepartment of Neurosurgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, GermanySection of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, PakistanDepartment of Neurosurgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany; Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Corresponding author. Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf. Germany.Introduction: Giant intracranial aneurysms (GIAs) of the anterior communicating artery (AComm) are rare and challenging to treat due to their distinct angioarchitecture. Research question: To review demographic, morphological, clinical, and prognostic factors in the treatment of giant AComm aneurysms to inform decision-making. Materials and methods: Medline, Scopus, and Cochrane databases were searched for records examining cases diagnosed with giant AComm aneurysms. The study type, sample size, patient age, aneurysm site, aneurysm size, presenting complaints, and treatment modality were tabulated, and methodological quality was assessed. Additionally, two cases from our institution were included. Results: The data from 24 retrieved records, including 45 cases (60% treated with direct clipping/clip reconstruction, 20% with surgical bypass±trapping, and 16% with endovascular/combined methods) were obtained. The mean age was 52 years with an overall male preponderance (3:1). 73% presented with symptoms; mostly visual impairment/loss and subarachnoid hemorrhage. 82% had favorable outcomes (mRS 0–2). 56% had a mean maximum diameter between 25 and 30 mm. Cases treated by direct clipping/reconstruction were primarily ruptured, while cases treated by surgical bypass/trapping were unruptured or asymptomatic. Endovascular/combined methods were utilized for only few cases. Discussion and conclusion: Immediate suspicion is warranted for visual impairment with headaches in adults or seizures in the elderly. Direct clipping is the first-line treatment for ruptured cases closely followed by surgical bypass and trapping for unruptured cases. There is limited data on endovascular/combined methods. Evidence from case reports/series should be interpreted with caution. Both inter-modality and intra-modality nuances exist.http://www.sciencedirect.com/science/article/pii/S2772529425000086Giant intracranial aneurysmAnterior communicating arteryCerebrovascular surgeryBypassDirect clippingEndovascular |
| spellingShingle | Roua Nasir Midhat e Zahra Naqvi Salaar Ahmed Maarij ul Hassan Rabeet Tariq Saad Akhter Khan Pia Koeskemeier Rajiv K. Khajuria Mohammad Hamza Bajwa Sajjad Muhammad The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases Brain and Spine Giant intracranial aneurysm Anterior communicating artery Cerebrovascular surgery Bypass Direct clipping Endovascular |
| title | The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases |
| title_full | The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases |
| title_fullStr | The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases |
| title_full_unstemmed | The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases |
| title_short | The morphological, clinical, and prognostic factors in the management of giant anterior communicating artery aneurysms: A systematic review of cases |
| title_sort | morphological clinical and prognostic factors in the management of giant anterior communicating artery aneurysms a systematic review of cases |
| topic | Giant intracranial aneurysm Anterior communicating artery Cerebrovascular surgery Bypass Direct clipping Endovascular |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000086 |
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