SynthesisNeurosurgical review2026
Management of hemorrhagic isolated pure lenticulostriate artery aneurysms: a systematic review and three illustrative cases.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hemorrhagic isolated aneurysms of the lateral or medial lenticulostriate arteries (LLSA/MLSA) are rare; evidence is limited to case reports and small series, so the benefit of treatment versus conservative management is uncertain. We reviewed published hemorrhagic isolated (non-malformation-associated) LLSA/MLSA aneurysms, extracting demographics, imaging presentation/aneurysm size, Hunt-Hess grade, management, complications/rebleeding, aneurysm status, mRS. Patients were grouped as treated (surgery/endovascular/radiosurgery) or conservative and compared with exact tests. Three additional conservatively managed cases are described. Forty-two publications reported 48 patients (median age 41.5; 24 men/23 women; 1 unreported). LLSA aneurysms predominated (37/48). Presentation: ICH 34/48, IVH 24/48, isolated SAH 7/48. Twenty-eight patients were treated (22 surgery, 5 endovascular, 1 radiosurgery) and 20 managed conservatively. Conservative patients had higher Hunt-Hess grades (median 4 vs 3) and none had isolated SAH. Rebleeding occurred in 3/20 (15%) conservative patients and 0/27 treated patients with available data. Surgical complications occurred in 10/22 (45%), mainly basal ganglia infarction. mRS was strongly associated with initial Hunt-Hess grade; within Hunt-Hess strata (1-3 vs 4-5),"good outcome" (mRS 0-2) rates were similar between treated and conservative groups. In our 3 cases, all conservatively managed aneurysms spontaneously resolved on follow-up imaging with mRS 0-2. Rebleeding was reported only after conservative management (15%), whereas intervention secured the aneurysm; however, surgical treatment was frequently complicated (45%). Our three conservatively managed cases showed spontaneous aneurysm resolution with mRS 0-2, highlighting the complexity of individualized decision-making when balancing rebleeding risk against treatment-related ischemic injury. Future multicenter registries are needed to better define management strategies.
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