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Ebook Decision making in neurovascular disease: Part 2

Part 2 book “Decision making in neurovascular disease” has contents: Superior cerebellar artery aneurysms, posterior inferior cerebellar artery aneurysm, mycotic intracranial aneurysms, pediatric intracranial aneurysms, spinal aneurysms, brainstem arteriovenous malformations, and other contents. | 32 Fusiform Aneurysms of the Anterior Circulation Leonardo B.C. Brasiliense, Pedro Aguilar-Salinas, Douglas Gonsales, Andrey Lima, Eric Sauvageau, and Ricardo A. Hanel Abstract The estimated prevalence of intracranial aneurysms (IA) in the general population ranges between 2 and 4%. Although fusiform aneurysms are more commonly found in the vertebrobasilar circulation, these challenging lesions can occur in the anterior circulation with a prevalence ranging from 0.1 to 0.3%. Fusiform aneurysms are complex lesions that involve more than 50% of the arterial circumference and are typically characterized by a lack of discernible neck. In general, this subset of lesions is associated with worse outcomes, higher rates of complications, and death. In this chapter, we discuss their anatomical features and explore pathophysiological mechanisms as well as current evidence in surgical and endovascular options. Microsurgery remains an adequate treatment option and some of the vascular reconstructions include trapping, wrapping, bypass, and excision and induction of aneurysm thrombosis by proximal clipping. Endovascular options for fusiform aneurysms are typically associated with the use of stents or flow diverters with or without the use of adjuvant coiling. Overall, these procedures have demonstrated a safe and effective profile favoring this option over microsurgery. However, in some instances, a combined approach can be done. Although there is no consensus for the optimal management of fusiform aneurysms in the anterior circulation, the decision is made on a case-by-case basis assessing the patient’s hemorrhagic risk over an estimated life span in contrast to neurosurgeon’s perceptions of potential complications, particularly major neurological morbidity and loss of functional independence. Keywords: intracranial aneurysm, fusiform aneurysm, surgery, endovascular Introduction Intracranial aneurysms are estimated to occur in approximately 2.8% of the general population and