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Microsurgical Treatment of ADPKD Patients With Intracranial Aneurysms: clinical experience of a tertiary vascular neurosurgery center

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorders with a prevalence rate of approximately 1 in 400 to 1 in 1000 individuals. Intracranial aneurysms are one of the most frequent vascular anomalies in ADPKD and still an important cause of morbidity and mortality in these patients. Methods: A retrospective observational investigation was carried out in two Brazilian tertiary referral vascular neurosurgery center, from January 2015 to March 2018. Results: Sixteen patients, 13 of them electively and 3 as emergency, and underwent treatment for twenty brain aneurysms were operated on. Twelve of them were female (75%) and the mean age was 58.3 years (47-73 years). The majority of aneurysms location was the anterior circulation, with 40% in the middle cerebral artery (MCA) and 35% in anterior communicating artery (ACoA). Fifteen patients (93.7%) underwent surgical clipping alone and one patient undergone surgical clipping plus endovascular treatment. In the elective group, 30% of the patients had postoperative hemorrhagic complications and 2 patients died, while in the other group, 2 patients had a good outcome and one died. Conclusion: Intracranial aneurysms are very common in patients with ADPKD and an important cause of morbidity and mortality for them, especially in cases with subarachnoid hemorrhage. If well-planned these patients treatment is safe and essential to maintain their quality of life and avoid the dreaded rupture of the aneurysm and the complications of subarachnoid hemorrhage.