Treatment Modalities & Outcome Trends of Complex Anterior Circulation Intracranial Aneurysms: a case series study

Background: Complex intracranial aneurysms (CIAs) are some of the most technically demanding neurosurgical pathologies. Although extensive work has been directed to the treatment of these challenging vascular lesions, no formal management guidelines exist to tackle this complex pathology. In this study, we evaluate contemporary clinical practice, as well as recent trends and outcomes in management of anterior circulation CIAs.Methods: This study is a prospective observational study that included 40 patients. All patients were evaluated by multidisciplinary team (MDT) consisting of neuro-endovascular radiologists, vascular neurosurgeons, and neurologists for assessment of the therapeutic options. Results: Twenty cases were managed surgically, while 18 were treated by various endovascular techniques. Surgical and endovascular modalities were used as a hybrid approach to treat 2 cases. Recurrence or residual of treated aneurysms was seen only in the endovascular cohort (Four cases out of the 18 cases treated by endovascular techniques). Four documented intervention related mortalities occurred during the first 6 months. Conclusion: CIAs managed surgically showed less recurrence rate than those treated by different endovascular techniques. CIAs treated by endovascular modalities showed much lower length of hospital stay and better modified Rankin scale after 6 months. Complications rate and mortality rate were similar in both groups and were usually related to the initial poor presentation with high World Federation of Neurosurgical Societies (WFNS) grades upon the initial ictus.