Kissing Aneurysms: Radiological and Surgical Difficulties in 30 Operated Cases and a Proposed Classification

Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

“…Several complexity criteria have been reported in the literature, including fusiform shape, large or giant size, vessel origin from the sac, thrombosis, previous treatments, wide neck, proximal vessel tortuosity, and calcifications [ 3 ]. The unruptured intracranial aneurysm score (UIATS) defines the aneurysmal complexity given the presence of a neck wider than the diameter of the parent vessel, calcified dome or proximal vessel tortuosity/stenosis, aneurysm thrombosis, or sac smaller than 3 mm [ 3 , 4 , 5 ]. Giant aneurysms and cases with a previous endovascular or surgical treatment can be likewise considered complex [ 4 , 6 , 7 , 8 ].…”

“…Any combination of these features can render conventional clipping unfeasible. While new definitions and classifications of aneurysm complexity have emerged [ 1 , 3 , 5 ], they often lack a quantitative assessment of the combined qualitative features and their relevance for treatment. This correlation between complexity features and treatment is increasingly crucial in a multidisciplinary context, especially for middle cerebral artery (MCA) aneurysms, which are the most frequently surgically treated [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

Kissing Aneurysms of the Anterior Communicating Artery Treated With Surgical Clipping: A Case Report and Literature Review

“…Since then, numerous case reports and a few small series (≤5 cases) have been published [ 6 , 7 ]. Inci and Karakaya reported an incidence of 3.6% in their retrospective review of an aneurysm series, identifying 30 patients with kissing aneurysms among 1,073 aneurysms in 817 operated patients [ 8 ].…”

“…In 2021, Inci and Karakaya proposed a classification of kissing aneurysms which had a major impact on the clip selection as well as the evaluation of the intraoperative difficulties based on the spatial relationship of the aneurysms on the parent artery from the surgeon’s perspective. The classification is divided into the following three types: type I (proximal/distal) - one aneurysm is positioned proximally and the other distally on the parent artery (this classification is particularly relevant in scenarios where one aneurysm may obscure the approach to or complicate the treatment of the other, affecting the surgical strategy); type II (superior/inferior) - one aneurysm is located superiorly and the other inferiorly (this arrangement can influence the order of clipping, as accessibility to one might be impeded by the position of the other, necessitating strategic planning in the clipping sequence); type III (right/left) - one aneurysm is located to the right and the other to the left (this type may present challenges in terms of ensuring clear surgical access and avoiding compromise of the parent artery during clipping) [ 8 ].…”