Diagnosis and management of false-positive intracranial aneurysms: a systematic review and illustrative cases.

Abstract

Purpose: To systematically review existing data on a false-positive diagnosis of an intracranial aneurysms and associated risks. Methods: A literature search in two databases (PubMed and Web of Science) using keywords "mimicking an intracranial aneurysm", "presenting as an intracranial aneurysm", "false positive intracranial aneurysms," and "neurosurgery” was conducted. We also presented two illustrative cases of patients operated on due to false diagnosis. Results: A total of 243 papers were found in the initial search in two databases. Sixteenpapers (including 20 patients) were included in the final analysis. There were 10 women and 10 men. The most common location of false-positive aneurysms was the bifurcation of the middle cerebral artery. In the posterior circulation, false-positive aneurysms were identified either on the basilar artery, or at the vertebro-basilar junction. Artery occlusion with vascular stump formation was the most common cause of false intracranial aneurysm diagnosis (55.0%). Most often, this variant was detected at the MCA bifurcation (63.6%). Other causes included infundibular widening, fenestration, arterial dissection, contrast extravasation, venous varix. Conclusion: Surgical interventions for false-positive aneurysms are an underestimated problem in vascular neurosurgery. Despite extremely rare published clinical observations, the actual frequency of erroneous surgical interventions for false-positive aneurysms is unknown.