Current experience of the treatment of multiple cerebral aneurysms (literature review)
Abstract
Multiple cerebral aneurysms are found in one among four patients with aneurysmal subarachnoid hemorrhage. Nowadays, there is no clear consensus regarding the optimal treatment of multiple cerebral aneurysms. The papers published up to December 2021 containing the results of endovascular treatment of multiple cerebral aneurysms. Treatment strategy, surgical methods, complications associated with the procedure, and mortality rates were analyzed. The treatment of multiple cerebral aneurysms remains an unresolved problem of vascular neurosurgery, in particular, there is no consensus on the optimal method of treatment and timing. Current evidence-based data indicate the advantage of minimally invasive techniques in the treatment of multiple cerebral aneurysms due to the low risk of complications and the possibility of one-session procedure. The question of treat or not to treat of unruptured aneurysms in the presence of multiple aneurysms is a matter of debate. The choice between surgical methods (microsurgical clipping or endovascular coiling) or observation requires a multidisciplinary approach, taking into account the risks of rupture and the corresponding procedures.
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References
Etminan N, Chang HS, Hackenberg K, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis. JAMA Neurol. 2019;76(5):588-97. https://doi.org/10.1001/jamaneurol.2019.0006.
Chan V, O’Kelly C. Response by Chan and O’Kelly to letter regarding article, “Declining admission and mortality rates for subarachnoid hemorrhage in Canada between 2004 and 2015”. Stroke. 2019;50(5):e133. https://doi.org/10.1161/STROKEAHA.119.025114.
Rinkel GJ, Djibuti M, Algra A, et al. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998;29(1):251-6. DOI: 10.1161/01.str.29.1.251 PMID: 9445359
Vajda J. Multiple intracranial aneurysms: a high risk condition. Acta Neurochir (Wien). 1992;118(1-2):59-75. DOI: 10.1007/BF01400727 PMID: 1414531
Rinne J, Hernesniemi J, Puranen M, et al. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 1994;35(5):803-8. DOI: 10.1227/00006123-199411000-00001 PMID: 7838326
Litvak SO. Іndivіdualіzacіja hіrurgіchnogo lіkuvannja arterіalnih anevrizm golovnogo mozku [dissertation]. Kyjiv: Instytut nejrohirurgiji im. akad. A.P. Romodanova; 2021. 312 р. Ukrainian
Shheglov DV, Gnelica AP. Jendovaskuljarnoe lechenie mnozhestvennyh meshotchatyh anevrizm golovnogo mozg (Russian). Ukrayinska intervencijna nejroradiologija ta hirurgija (Ukrainian). 2012;3-4:060-7. DOI: 10.0000/cyberleninka.ru/article/n/endovaskulyarnoe-lechenie-mnozhestvennyh-meshotchatyh-anevrizm-golovnogo-mozga
Skorohod II. Mnozhynni arterialni anevryzmy golovnogo mozku: diagnostyka ta hirurgichne likuvannja [dissertation]. Kyjiv: Instytut nejrohirurgiji im. akad. A.P. Romodanova; 2008. 176 р. Ukrainian
Cho YD, Ahn JH, Jung SC, et al. Single-stage coil embolization of multiple intracranial aneurysms: Technical feasibility and clinical outcomes. Clin Neuroradiol. 2016 Sep;26(3):285-90. doi: 10.1007/s00062-014-0367-6. Epub 2014 Dec 17. PMID: 25516149.
Kheyreddin AS, Filatov IuM, Iakovlev SB [Stage-by-stage treatment of multiple cerebral aneurysms using endovascular and microsurgical techniques]. Vopr Neirokhir im NN Burdenko. 2009 Jan-Mar;(1):53-7; discussion 58-9. Russian. PMID: 19505031.
Richardson JC, Hyland HH. Intracranial aneurysms. Medicine. 1941;20:1-83.
Dandy WE. Intracranial arterial aneurysms. Ithaca, New York Comstock;1944. 147 р. https://wellcomecollection.org/works/sd7phf7c
Hamby WB. Intracranial aneurysms. Thomas, Springfield, Ill; 1952.
Jabbarli R, Dinger TF, Darkwah Oppong M, et al. Risk factors for and clinical consequences of multiple intracranial aneurysms: A systematic review and meta-analysis. Stroke. 2018 Apr;49(4):848-55. doi: 10.1161/STROKEAHA.117.020342. Epub 2018 Mar 6. PMID: 29511128
Heiskanen O, Marttila I. Risk of rupture of a second aneurysm in patients with multiple aneurysms. J Neurosurg. 1970;32(3):295-9. DOI: 10.3171/jns.1970.32.3.0295 PMID: 5416913
Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms: review of experience with 372 cases. Acta Neurochir (Wien). 1989;96(1-2):8-14. DOI: 10.1007/BF01403489 PMID: 2929394
Inagawa T. Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien). 1991;108(1-2):22-9. DOI: 10.1007/BF01407662 PMID: 2058422
Orz Y, Osawa M, Tanaka Y, et al. Surgical outcome for multiple intracranial aneurysms. Acta Neurochir. (Wien). 1996;138(4):411-7. doi: 10.1007/BF01420303.
Nemoto M, Yasui N, Suzuki A, et al. [Problems of surgical treatment for multiple intracranial aneurysms]. Neurol Med Chir (Tokyo). 1991;31(13):892-8. Japanese. doi: 10.2176/nmc.31.892.
Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke. 2003 Jan;34(1):16-21. doi: 10.1161/01.str.0000046763.48330.ad. PMID: 12511744.
Forsting M, Wanke I, eds. Intracranial vascular malformations and aneurysms: From diagnostic work-up to endovascular therapy. 2nd ed. Springer; 2008. 297 p. ISBN: 978-3-540-32920-6
Nehls DG, Flom RA, Carter LP, Spetzler RF. Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg. 1985 Sep;63(3):342-8. DOI: 10.3171/jns.1985.63.3.0342 PMID: 4020459
Joseph S, Kamble R. Current trends in endovascular management of intracranial aneurysms (including posterior fossa aneurysms and multiple aneurysms). Indian J Radiol Imaging. 2008 Aug;18(3):256-63. doi: 10.4103/0971-3026.41841. PMID: 19774171. PMCID: PMC2747444.
Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002 Jan;33(1):210-7. DOI: 10.1161/hs0102.100486 PMID: 11779912
Kim YJ, Song KY. Endovascular coiling of multiple (more than four) intracranial aneurysms. Case report. Interv Neuroradiol. 2004;10(1):75-81. doi:10.1177/159101990401000110
Raymond J, Guillemin F, Proust F, Molyneux AJ, Fox AJ, Claiborne JS, Meder JF, Rouleau I; Trial ON Endovascular Aneurysm Management (TEAM) Collaborative Group: Unruptured intracranial aneurysms. A critical review of the international study of unruptured intracranial aneurysms (ISUIA) and of appropriate methods to address the clinical problem. Interv. Neuroradiol. 2008;14(1):85-96. doi: 10.1177/159101990801400111. Epub 2008 May 12. PMID: 20557790
Koźba-Gosztyła M, Czapiga B, Jarmundowicz W. Aneurismal subarachnoid hemorrhage: who remains for surgical treatment in the post-ISAT era? Arch. Med. Sci. 2015;11(3):536-43. DOI: 10.5114/aoms.2013.37333 PMID: 26170846. PMCID: PMC4495139
Pierot L, Boulin A, Castaings L, Rey A, Moret J. The endovascular approach in the management of patients with multiple intracranial aneurysms. Neuroradiology. 1997;39(5):361-6. DOI: 10.1007/s002340050425 PMID: 9189884
Massoud TF, Guglielmi G, Viñuela F, Duckwiller GR. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. Am J Neuroradiol. 1996;17(3):549-54. PMCID: PMC8337990. PMID: 10200108
Shen Xun et al. Multiple intracranial aneurysms: endovascular treatment and complications. Interventional Neuroradiology: Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences. 2014;20(4):442-7. doi:10.15274/INR-2014-10037
Jeon P, Kim BM, Kim DJ, Kim DI, Suh SH. Treatment of multiple intracranial aneurysms with 1-stage coiling. Am J Neuroradiol. 2014 Jun;35(6):1170-3. doi: 10.3174/ajnr.A3821. Epub 2013 Dec 26. PMID: 24371032. PMCID: PMC7965134.
Oh K, Lim YC. Single-session coil embolization of multiple intracranial aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15(3):184-90. doi:10.7461/jcen.2013.15.3.184
Xavier AR, Rayes M, Pandey P, Tiwari A, Kansara A, Guthikonda M. The safety and efficacy of coiling multiple aneurysms in the same session. J Neurointerv Surg. 2012 Jan 1;4(1):27-30. doi: 10.1136/jnis.2009.001974. Epub 2011 Apr 14. PMID: 21990433.
Andic C, Aydemir F, Kardes O, et al. Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once? J Neurointerv Surg. 2017;9(11):1069-74. DOI: 10.1136/neurintsurg-2016-012745 PMID: 27977003
Murrone D, Romanelli B, Ierardi A. Surgical case series of multiple aneurysms: A single-centre experience of 16 years. Case Reports. Int J Surg. 2018;42:191-5. doi:10.1016/j.ijscr.2017.12.011
Dong QL, Gao BL, Cheng ZR, et al. Comparison of surgical and endovascular approaches in the management of multiple intracranial aneurysms. Int J Surg. 2016 Aug;32:129-35. doi: 10.1016/j.ijsu.2016.07.004. Epub 2016 Jul 8. PMID: 27398690.
Rotim K, Kalousek V, Splavski B, Tomasović S, Rotim A. Hybrid microsurgical and endovascular approach in the treatment of multiple cerebral aneurysms: An illustrative case series in correlation with literature data. Acta Clinica Croatica. 2021;60(1):33-40. https://doi.org/10.20471/acc.2021.60.01.05
Chung J, Shin YS. Multiple intracranial aneurysms treated by multiple treatment modalities. Neurosurgery. 2011 Oct;69(4):E1030-2. doi: 10.1227/NEU.0b013e31822a5280. PMID: 21709595.
Ling JA, D’Urso PS, Madan A. Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage. J Clin Neurosci. 2006 Aug;13(7):784-8. doi: 10.1016/j.jocn.2005.09.009. Epub 2006 Jul 11. PMID: 16815018.
Rajagopal N, Yamada Y, Balaji A, Kawase T, Kato Y. Rare cases of multiple unruptured intracranial aneurysms: Illustrative report and review on management options. Interdisciplinary Neurosurgery. 2019;18:100466. https://doi.org/10.1016/j.inat.2019.04.011
Wilson FMA, Jaspan T, Holland IM. Multiple cerebral aneurysms: a reappraisal. Neuroradiology. 1989;31(3):232-6. doi: 10.1007/BF00344349.
Mont’alverne F, Tournade A, Riquelme C, Musacchio M. Multiple intracranial aneurysms. Angiographic study and endovascular treatment. Interventional Neuroradiology: Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences. 2002;8(2):95-106. https://doi.org/10.1177/159101990200800201.

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