Treatment of ruptured lenticulostriate artery aneurysms

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  • 1 Departments of Neurological Surgery and Radiology, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey; and
  • 2 Departments of Neurosurgery and
  • 3 Radiology, Mount Sinai School of Medicine, New York, New York
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Object

Lenticulostriate artery (LSA) aneurysms are rarely reported in the literature, making management decisions challenging. Conservative, endovascular, and surgical treatments have been described primarily through case reports and reports of individual authors' experiences. The purpose of this study is to report neurological outcomes in a single-institution experience of ruptured lenticulostriate aneurysms treated surgically.

Methods

The authors have conducted a retrospective review of all cases involving patients with ruptured LSA aneurysms who presented to the Mt. Sinai Hospital neurosurgical service between September 2001 and January 2007.

Results

Over 5.4 years, the authors treated 6 patients with 7 LSA aneurysms—6 ruptured and 1 unruptured. The Hunt and Hess grade on admission ranged from I to IV, with subarachnoid hemorrhage in 5 of the 6 patients. Catheter angiography confirmed the presence of the aneurysms, and all patients underwent a pterional craniotomy and clipping or resection of the aneurysm, performed by a single surgeon.

Associated risk factors in our series of patients included hypertension, cocaine abuse, and intracranial occlusive disease suggestive of moyamoya disease. Two types of LSA aneurysms were identified. The mean size of the 6 ruptured aneurysms was 3.2 mm. The LSA was preserved in 3 of 6 patients, but LSA preservation did not correlate with development of a postoperative infarct, clinically or radiologically. In patients with ruptured aneurysms, the mean modified Rankin Scale score at discharge was 1.7. The 3 patients in whom the LSA was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated.

Conclusions

This case series demonstrates that surgical treatment of ruptured LSA aneurysms can be an appropriate, effective, and safe therapy.

Abbreviations used in this paper: ACA = anterior cerebral artery; ICA = internal carotid artery; ICH = intracerebral hemorrhage; IPH = intraparenchymal hemorrhage; LOS = length of hospital stay; LSA = lenticulostriate artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Chirag Gandhi, M.D., UMDNJ–Neurological Institute of New Jersey, 90 Bergen Street, Suite 8100, Department of Neurological Surgery, Newark, New Jersey 07101. email: gandhich@umdnj.edu.
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