Abstract
Lenticulostriate artery (LSA) aneurysms are a rare subset of intracranial aneurysms that are challenging to manage because of their location, small size, unusual morphology, and supply of eloquent parenchyma. This study reports a single-surgeon, multi-institutional experience and literature review.BACKGROUND AND OBJECTIVESLenticulostriate artery (LSA) aneurysms are a rare subset of intracranial aneurysms that are challenging to manage because of their location, small size, unusual morphology, and supply of eloquent parenchyma. This study reports a single-surgeon, multi-institutional experience and literature review.Patients with cerebrovascular pathology treated by a single neurosurgeon were queried from a prospectively maintained clinical database to find all patients treated for LSA aneurysms between 1997 and 2021. Aneurysms were categorized by LSA aneurysm type. A systematic review of articles published from January 2021 to October 2023 was conducted to identify all reported cases of LSA aneurysms.METHODSPatients with cerebrovascular pathology treated by a single neurosurgeon were queried from a prospectively maintained clinical database to find all patients treated for LSA aneurysms between 1997 and 2021. Aneurysms were categorized by LSA aneurysm type. A systematic review of articles published from January 2021 to October 2023 was conducted to identify all reported cases of LSA aneurysms.In the institutional cohort, a total of 27 patients with LSA aneurysms were identified and included. The mean (SD) patient age was 49.5 (14.5) years; 7 patients were male, and 20 were female. Thirteen aneurysms were left-sided, and 14 were right-sided. In these patients, there were 7 type I aneurysms (26%), 9 type IIa aneurysms (33%), 2 type IIb aneurysms (7%), and 9 type III aneurysms (33%). Clipping was performed in 21 patients (78%), excision in 4 (15%), bypass in 1 (4%), and wrapping in 1 (4%). One patient experienced a surgical complication, and a favorable neurological outcome (modified Rankin Scale score ≤2) was achieved in 19 patients (70%). No patients were found to have residual aneurysm or recurrence, and none required retreatment. The systematic review identified 8 published studies with 9 cases of LSA aneurysms.RESULTSIn the institutional cohort, a total of 27 patients with LSA aneurysms were identified and included. The mean (SD) patient age was 49.5 (14.5) years; 7 patients were male, and 20 were female. Thirteen aneurysms were left-sided, and 14 were right-sided. In these patients, there were 7 type I aneurysms (26%), 9 type IIa aneurysms (33%), 2 type IIb aneurysms (7%), and 9 type III aneurysms (33%). Clipping was performed in 21 patients (78%), excision in 4 (15%), bypass in 1 (4%), and wrapping in 1 (4%). One patient experienced a surgical complication, and a favorable neurological outcome (modified Rankin Scale score ≤2) was achieved in 19 patients (70%). No patients were found to have residual aneurysm or recurrence, and none required retreatment. The systematic review identified 8 published studies with 9 cases of LSA aneurysms.This study presents the largest case series of LSA aneurysms to date. Satisfactory outcomes were observed across LSA types, and no patients required retreatment or had residual or recurrent aneurysms. These results indicate that open surgical management of LSAs can provide an effective and durable method of treatment.CONCLUSIONThis study presents the largest case series of LSA aneurysms to date. Satisfactory outcomes were observed across LSA types, and no patients required retreatment or had residual or recurrent aneurysms. These results indicate that open surgical management of LSAs can provide an effective and durable method of treatment.