Microsurgery and Endovascular Therapy for Distal Anterior Cerebral Artery Aneurysm: A Multicenter Retrospective Cohort Study

Thomas Metayer; Vianney Gilard; Michel Piotin; Evelyne Emery; Alin Borha; Erwan Robichon; Anais R Briant; Stephane Derrey; Denis Vivien; Thomas Gaberel

doi:10.1016/j.wneu.2023.07.022

Microsurgery and Endovascular Therapy for Distal Anterior Cerebral Artery Aneurysm: A Multicenter Retrospective Cohort Study

World Neurosurg. 2023 Oct:178:e174-e181. doi: 10.1016/j.wneu.2023.07.022. Epub 2023 Jul 13.

Authors

Affiliations

¹ Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France. Electronic address: thomas.metayer@neurochirurgie.fr.
² Department of Neurosurgery, University Hospital of Rouen, Rouen, France.
³ Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France.
⁴ Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France.
⁵ Department of Biostatistics, University Hospital of Caen, Caen, France.
⁶ Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France.
⁷ Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France; Medical School, University of Caen Normandy, Caen, France.

PMID: 37451360
DOI: 10.1016/j.wneu.2023.07.022

Abstract

Background: Distal anterior cerebral aneurysm (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available: microsurgery and endovascular therapy (EVT).

Objective: To compare the results between microsurgery and EVT in a modern French cohort.

Methods: A multicenter retrospective cohort study of 3 French neurosurgical units was carried out from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment for a ruptured or unruptured DACA aneurysm.

Results: A total of 69 patients were included; 16 patients (23.2%) were treated by microsurgery and 53 (76.8%) were treated by EVT. Thirty-one patients (44.9%) had ruptured aneurysms. The complication rate was low, with 1 death and 1 symptomatic ischemia. There was no difference in complications between microsurgery and EVT (P = 0.22). The number of retreatments was higher in EVT (15% vs. 0%) but not significantly (P = 0.18).

Conclusions: In the specific subgroup of DACA, both treatment modalities are effective in ruptured and unruptured aneurysms, with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complications.

Keywords: Daca aneurysms; Endovascular therapy; Microsurgery.