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Background: Fusiform aneurysms are a distinct subgroup of intracranial aneurysms with unique characteristics and pose a treatment challenge compared to common saccular aneurysms. Traditionally, surgery was the main treatment; however, endovascular techniques are gaining favor., Methods: We searched major databases for studies on treatment, clinical outcomes, and radiological outcomes of intracranial fusiform aneurysms published before May 31st, 2023 in order to compare surgical Vs endovascular treatment strategies. Pooled data analysis was performed using a random-effects model., Results: This systematic review and meta-analysis analyzed 1704 patients with 1737 fusiform aneurysms from 63 studies. Endovascular treatment, particularly stent-assisted coiling and stenting, emerged as the preferred approach with lower mortality and complication rates compared to surgery. Aneurysm location played a role in outcomes, with anterior circulation aneurysms generally faring better. Deconstructive strategies, designed to occlude the parent artery, carried a doubled risk of complications compared to reconstructive approaches, which aim to preserve blood flow (OR: 2.188; 95% CI: 1.474-3.248; p < 0.001)., Conclusion: Endovascular techniques are becoming the mainstay of treatment for fusiform aneurysms, offering improved safety and efficacy compared to surgery. Anterior circulation location and reconstructive strategies are associated with better outcomes. However, no significant differences in OR for early complete occlusion were found between surgery and endovascular techniques at discharge and follow-up with very low heterogeneity among studies., Competing Interests: Declarations: All authors have read and approved the submitted manuscript. Consent for publication: The manuscript has not been submitted nor published elsewhere in whole or in part. Conflict of interest: The authors declare no competing interests. Ethical statement: IRB approval was not required in our institutions for systematic review papers., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The management of superior cerebellar aneurysms is still controversial. Although several techniques are available, the deep localization of the lesion and the limited number of cases increase the complexity of decision-making for optimal treatment. Only a few cases of dissecting and fusiform aneurysms of the superior cerebellar artery (SCA) are described in the literature, many of which are without long follow-ups. The study aims to offer an exhaustive retrospective analysis of patients affected by SCA fusiform and dissecting aneurysms treated at our institution from 2008 to 2023, highlighting outcomes and complications. Moreover, a comprehensive narrative review was performed. A total of seven patients were treated at our institution. After a title and abstract screen, fifty-five papers met the criteria for inclusion in the review. In our case series, conservative treatment was proposed as the first therapeutic option in four cases (57.1%), while endovascular treatment (EVT) was in three cases (42.9%). A good recovery was observed in 66% of patients presenting with subarachnoid hemorrhage (SAH), while every patient without SAH achieved a good clinical outcome. A poor outcome was observed only in one patient with a dissecting aneurysm causing SAH, who also suffered a pontine infarction. In the literature review, conservative treatment was proposed as a first therapeutic option in eleven cases (16.6%), open microsurgical techniques in 19 patients (28.8%), and EVT in 31 patients (46.9%). Fatal outcome was documented in five patients (7.5%), all characterized by the rupture of the vascular lesion, while 6.1% of cases had non-fatal poor outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The anterior inferior cerebellar artery (AICA) plays a crucial role in cerebellar blood supply, and AICA aneurysms are relatively rare, comprising less than 1-1.5% of all brain aneurysms. Understanding their clinical scenarios, management approaches, and outcomes is essential. This systematic review analyzes data from 86 studies to comprehensively explore AICA aneurysms., Materials and Methods: The process of obtaining relevant research, which includes patients with AICA aneurysms, was carried out using the PubMed, Web of Science, and Scopus databases. This review exclusively included extensive papers written in English. The search included the MeSH phrases "Anterior inferior cerebellar artery aneurysm" and "AICA aneurysm." Microsurgical and endovascular treatments were compared using statistical analysis, exploring demographics, risk factors, treatment modalities, and clinical outcomes., Results: The review includes 85 case reports and one retrospective study, totaling 140 patients. The study reveals a diverse patient profile with a slight female predominance (65%), a mean age of 50.7 years, and an 82.86% prevalence of no identified risk factors. Ruptured aneurysms accounted for 55%, with microsurgery and endovascular procedures accounting for 70.71% and 27.86%, respectively. The mortality rate was 2.86%, and no significant differences were found in rebleed, recurrence, or mortality rates between treatment groups., Conclusion: Microsurgical and endovascular interventions demonstrate comparable effectiveness, with microsurgery showing superiority in specific situations. Therefore, tailoring treatment is crucial to individual patient needs. Subgroup analyses highlight demographic-specific trends, guiding clinicians in managing this rare pathology., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Basilar artery aneurysms account for approximately 5% of all intracranial aneurysms. This bibliometric analysis summarizes the most-cited articles on basilar artery aneurysms and highlights the contributing articles to today's evidence-based practice. In the execution of this bibliometric-based review article, the Scopus database was used to perform a title-specific, keyword-based search for all publications until August 2022. The keyword "basilar artery aneurysm" or "basilar aneurysm" was used. Our results were arranged in descending order based on the article's citation count. The 100 most cited articles were selected for analysis. Parameters included the following: title, citation count, citations per year, authors, specialty of first author, institution, country of origin, publishing journal, Source Normalized Impact Per Paper (SNIP), and Hirsch index. The keyword-based search showed that 699 articles were published between 1888 and 2022. The top 100 articles were published between 1961 and 2019. The top 100 most cited articles collected a total of 8869 citations with an average of 89 citations per paper. The rate of self-citations accounted for an average of 4.85% of the total number of citations. The bibliometric analysis provides a quantitative overview of how medical topics and interventions are analyzed in academic medicine. In the present study, we evaluated the global trends in basilar artery aneurysms by finding the top 100 most cited papers., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Endovascular coiling has revolutionized intracranial aneurysm treatment; however, recurrence continues to represent a major limitation. The hydrogel coil was developed to increase packing density and improve neck healing and therefore decrease recurrence rates. In this paper, we review treatment outcomes of first- (1HCs) and second-generation (2HCs) hydrogel coils and compare them to those of bare platinum coils (BPC). A query of multiple databases was performed. Articles with at least 10 aneurysms treated with either 1HC or 2HC were selected for analysis. Collected data included aneurysm size, rupture status, initial occlusion, initial residual neck/aneurysm, packing density, mortality, morbidity, recurrence, and retreatment rates. The primary endpoint was recurrence at final follow-up. Secondary endpoints included residual neck and dome rates as well as procedure-related complications and functional dependence at final follow-up. Studies that compared 1HC to BPC showed significant lower recurrence (24% vs. 30.8%, p = 0.02) and higher packing density (58.5% vs. 24.1%, p < 0.001) in 1HC but no significant difference in initial occlusion rate (p = 0.08). Studies that compared 2HC to BPC showed lower recurrence (6.3% vs. 14.3%, p = 0.007) and retreatment rates (3.4% vs. 7.7%, p = 0.010) as well as higher packing density (36.4% vs. 29.2%, p = 0.002) in 2HC, with similar initial occlusion rate (p = 0.86). The rate of complications was not statistically different between HC (25.5%) and BPC (22.6%, p = 0.06). Based on our review, the 1HC and 2HC achieved higher packing density and lower recurrence rates compared to BPC. The safety profile was similar between both groups., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different aspects of isolated spinal aneurysms using the PubMed, Ovid MEDLINE, and Google Scholar databases. Eighty-two papers reporting 107 individual patient cases were included. Most isolated spinal aneurysms have a fusiform morphology, and are most commonly found in the anterior spinal artery at the thoracic or cervical levels. Subarachnoid hemorrhage is the most common form of presentation, and sudden onset back pain is the most common initial symptom. The diagnosis of spinal aneurysms requires a high degree of clinical suspicion. Because of their small size, they can be missed on CT/MR angiography and spinal angiogram may be employed. Treatment of spinal aneurysms should be individualized on a case-by-case basis. Conservative management can be a valid option in spinal aneurysms where the risk of treatment is high. Surgical or endovascular intervention may be indicated in cases of significant or progressive neurologic decline due aneurysmal mass effect, or progressive growth of the aneurysm despite conservative treatment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Ruptured intracranial aneurysms, as the leading cause of spontaneous subarachnoid hemorrhage (aSAH), represents an emergency with high morbi-mortality. The comprehension of the underlying pathology that involves inflammatory and immune responses, through the neutrophil-to-lymphocyte ratio (NLR), could help to predict complications such as delayed cerebral ischemia (DCI) or rebleeding and the functional outcome. Systematic review of English-based literature through PubMed and Biblioteca Vitural em Saúde (BVS) to find papers discussing the use of NLR in the aSAH setting. Area-under-curve (AUC) of receiver operating characteristics (ROC), cutoff value, sensitivity, and specificity were retrieved. From 53 articles included, 4 papers were evaluated after exclusion criteria. Rebleeding could be predicted with a NLR cutoff value of 9.88 (sensitivity 72.3%, specificity 63.3%). The mean cutoff value for DCI was 12.85, with sensitivity 66.3% and specificity 75.8%. Finally, a worse 3-month functional outcome could be predicted with a mean sensitivity of 73.3% and a mean specificity of 54%. NLR is a new issue in scientific community, especially neurosurgery. The current understanding points to a multifactorial process after aSAH that emerges as alterations on the NLR. As a measurement readily available and cost-effect after admission of the patient, its use signals that patients that need expedite surgical treatment or more aggressive treatment for vasospasm. As other medical subspecialties already use this ratio to predict outcomes, the literature reviewed by this paper constitute the earliest clues that higher NLR predicts re-bleeding, DCI, and functional outcome., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Unruptured intracranial saccular aneurysms occur in 3-5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Aneurysms located on the posterior inferior cerebellar artery are rare, and treatment guidelines for them have not yet been established. In this paper, we present the results of a retrospective study which analyzes the management and treatment of 15 patients with posterior inferior cerebellar artery aneurysms from 2004 to 2013. The aneurysms were ruptured and presented with a subarachnoid hemorrhage. Of the 15 aneurysms, ten were of saccular, three fusiform, and two were dissecting. Computed tomography angiography or digital subtraction angiography revealed other aneurysms or intracerebral artery hypoplasia in seven patients. Either surgical or endovascular treatment was performed depending on the localization and morphology of the aneurysm. Six aneurysms were coiled, and surgery was performed in nine cases. Of the nine surgically treated patients, six (75%) had good outcomes. Of the six patients treated using endovascular procedures, three patients (50%) recovered. Patient outcomes were classified using the Hunt&Hess scale. Patients with Hunt&Hess 1-3 recovered without a neurological deficit. On the other hand, patients with Hunt&Hess 4-5 had a risk of up to 93% of death or a poor outcome. In two cases of endovascular and in two cases before any therapy, aneurysmal rebleeding occurred and resulted in deterioration of clinical state of the patient and a poor prognosis with high risk of death. This study shows the necessity of acute treatment of posterior inferior cerebellar artery aneurysm, of thorough diagnostic, and of interdisciplinary cooperation.

Basilar artery bifurcation aneurysms (BAAs) constitute a major surgical challenge, due to the depth of the target anatomy and narrowness of field, the close relationship with thalamoperforating arteries, and difficulty in obtaining proximal control. Moreover, to treat these aneurysms may be especially technically demanding when situated in a low-lying basilar apex configuration. The most used approaches to treat BAA are the subtemporal approach and the pterional approach. The advantages and disadvantages of these techniques are very well known. Variations of these approaches were created attempting to overcome the limitations imposed by the limited deep operative area. They have not been able to improve the working space in the depths of the interpeduncular and prepontine cisterns. The transcavernous approach was devised as a means of enlarging the area of exposure around the interpeduncular and prepontine cisterns. It involves the removal of the anterior clinoid process, cutting distal and proximal dural rings, opening the cavernous sinus, and drilling varied extension of dorsum sellae and clivus. The senior author (EdO) has used a pretemporal approach to deal with BAAs. The authors have added a transcavernous approach in a pretemporal perspective to treat low-lying, complex, or giant basilar artery aneurysms. In this paper, the authors detail its anatomical principles and technical nuances and present the clinical experience with using this technique.

Paraclinoid aneurysms constitute formidable surgical challenge. The complex surgical anatomy and several factors such as size and projection of the lesion, choice of the surgical approach, relationships between the aneurysm and perforator vessels, site of proximal control, and potential improvement or worsening of visual symptoms account for these difficulties. In such complex cases, surgical nuances frequently determine the final outcome. In this paper, the authors present a comprehensive review of the tricky regional anatomy and describe the operative nuances one of the senior authors (E. dO.) has used to operate on these complex lesions.

In 1996, Civit et al. (Neurosurgery, 38:955-961, 1996) reported a series of eight patients whose aneurysms were clipped after previous embolization with coils. This paper highlighted the safety of this surgery in second line, with a low complication rate and a favorable outcome. The two major surgical indications were either after deliberate partial occlusion of the aneurysm (N=3) or partial occlusion after endovascular treatment (N=3). Reviewing 13 additional patients from 1996 to June 2005, the authors compared the surgical indications and focused on the technical problems of clipping after coiling. Thirteen patients (men=6, women=7) with aneurysm clipping following one or more endovascular embolizations have been operated on since 1996. The patients' files were reviewed retrospectively by both a senior consultant neurosurgeon and a neuroradiologist. Demographic data included sex, age at admission, relevant medical history, initial endosaccular treatment and its quality (partial or complete effectiveness), the rationale for surgery, and the complications arising from the different treatments. In addition to the patient's clinical follow-up, angiograms were performed soon after the surgical procedure, 3 months, 1 year, and 5 years after the coiling, respectively. None of the initial endovascular treatments was complete. Surgical indication was related firstly to anatomical particularities of the aneurysm (width of the neck, N=5; arterial branches from the aneurysm, N=4; no individualized neck in a small aneurysm, N=1); secondly to a shift of the coils with delayed aneurysm regrowth and repermeabilization, N=4; and thirdly to rebleeding, N=3. All the patients who were operated on underwent complete surgical exclusion of their aneurysm (controlled by angiogram). Twelve out of 13 patients recovered satisfactorily (92.3%), attaining the same neurological state they presented prior to surgery. One patient died after the operation. He had already been in a serious condition because of severe rebleeding following the embolization. Aneurysm clipping following a previous endovascular embolization procedure is a rare, although not so exceptional, indication. It is a safe and effective procedure, probably under-used. Nowadays, "hemostatic" and incomplete embolization of an aneurysm increases the risk of future growth and rebleeding of the residual pouch. An additional aneurysm clipping may therefore be required rapidly after embolization.

Brucellosis is a multisystem disease that may present with a large spectrum of clinical manifestations. Only five cases of intracranial aneurysm formation and/or subarachnoidal hemorrhage associated with brucellosis have been reported. In this paper, we take the opportunity to review these reports and present a new case of basilar artery aneurysm and subarachnoidal hemorrhage due to brucellosis.

Patients infected with the human immunodeficiency virus (HIV) or suffering from acquired immunodeficiency syndrome (AIDS) are now surviving for longer periods of time secondary to improvements in medical management. As the classical causes of morbidity and mortality in this patient population have come under better control, new complications are becoming more prevalent. In our clinical practice, there appears to have been a rise in the number of patients with HIV infection and AIDS who have experienced aneurysmal subarachnoid hemorrhage (SAH). In this paper, we review the available literature regarding cerebral aneurysms in patients infected with HIV and/or suffering from AIDS.

A 40-year-old man with mutism developed after clipping a left distal anterior cerebral artery aneurysm is presented. The most characteristic presenting symptom was complete absence of speech with unimpaired consciousness which occurred on the fourth day after operation. The patient recovered spontaneously within three weeks. In this paper we discuss the possible pathogenesis and anatomical location of mutism related to a distal anterior cerebral aneurysm in view of the literature.

Whereas previously the dissection of arteries leading to the brain was thought to be a rare occurrence, this diagnosis has been found more frequently in the last years as a result of newer imaging methods. Furthermore, in contrast to earlier opinions, there is a rather good prognosis for the recanalisation of the vessels and the restoration of the patient's health. In this paper, three cases with nearly typical constellation of symptoms and beneficial outcome are demonstrated. The related Doppler sonographical findings including duplex scan as well as the angiographical, computer tomographical and magnetic resonance tomography results are reported. It is to be noted that none of the three patients had a severe trauma or belonged to typical risk groups for a spontaneous dissection (Marfan's Syndrome, fibromuscular dysplasia.