TITLE:
Pericallosal Artery Aneurysms: Twenty-Six Years of Microneurosurgical Endeavor in Three Major Neurosurgical Centers in Abidjan
AUTHORS:
Médard Kakou, Alban Slim Mbende, Daouda Sissoko, Fulbert Kouakou
KEYWORDS:
Pericallosal Artery Aneurysm, Pericallosal Artery, Microsurgery, Treatment, Abidjan
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.7 No.4,
September
18,
2017
ABSTRACT: We present our experience of
microsurgical treatment of pericallosal artery aneurysms (PCAA) in three
neurosurgical centers in Abidjan (Ivory Coast) from 1990 to 2016. This present
study aimed to evaluate characteristics of 6 patients with PCAA treated during
a 26-year period and to establish the rate, clinical nuances, anatomical
variations and respective microsurgical approaches of PCAA in Abidjan. We
analyzed medical files of all 93 patients admitted for an intracranial aneurysm
between 1990 and 2016 and focused on the 6 patients who were treated for a
PCCA. The mean age of patients was 37 years, half of whom were less than 30
years old. They were 3 men and 3 women. The time from first symptom to
admission was more than 3 days, but less than 16 days. Five out of six patients
had ruptured aneurysms and the clinical condition on admission was WFNS grade 0
one patient (16.67%) and WFNS I-III five patients (83.33%). Analysis of
radiological data revealed Fischer grade IV three patients and Fischer grade
I-II three patients. A total of 7 PCCA were recorded and they accounted for
6.19% of all intracranial aneurysms and 9.72% of all anterior circulation
aneurysms. Six out of seven aneurysms (85.71%) were either smaller (2 - 6 mm)
or middle sized (6 - 15 mm). There was only one (14.29%) giant PCA aneurysm
(>25 mm). According to the location, two aneurysms (28.57%) were located on
the A2 segment of the pericallosal artery (PCA) and five (71.43%) on the A3
segment of the artery. We found 4 cases of saccular aneurysms (57.14%) and 3
cases of fusiform aneurysms (42.86%), two of which were located on A2 segments
of the 2 PCA on the same patient (16.67%). We didn’t find any PCA anatomical
variation associated with any of the 7 aneurysms. Two patients developed
perioperative rebleeding and in 1 case a severe preoperative hydrocephalus was
diagnosed. The median time from rupture to surgery was 59.5 days with a range
of 14 to 180 days. Treatment techniques included 4 clipping (57.14%) and 3
wrapping (42.86%). In 2 cases there was premature perioperative rupture of the
aneurysm (33.33%). One patient (16.67%) had postoperative persistent anosmia
and, we didn’t record any fatal outcome in our series. PCAA remain rare
anterior circulation aneurysms, located in the vast majority of cases, on the
A3 segment of the PCA and, are mostly smaller in size even when ruptured.
Microsurgical clipping remains a safe and effective treatment option despite
their complex surgical approaches and the risk of premature rupture.