Perianeurysmal cyst formation post embolization and its management: case presentation and systematic review of an uncommon entity

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Abstract
Background Perianeurysmal cyst (PC) formation post-aneurysm embolization is an uncommon entity that can develop post-rupture or unruptured aneurysm treatment. PCs may present with different clinical presentations depending on the initial aneurysm. Currently, there is no standardized treatment for perianeurysmal cysts. Methods We performed a systematic review of perianeurysmal cyst cases. A literature search was performed on PUBMED, Science Direct, and Web of Science using the terms: “peri aneurysm” OR “perianeurysmal” OR “peri-aneurysm” AND “cyst” OR “cysts” OR “cystic”. We also included a case from our institution. Results A total of twenty-six cases were included. Most of the patients were males with a mean age of presentation of 59.34 years. Mass effect and hydrocephalus were the most common clinical presentation with 60% of the cases presenting headaches. The majority of the patients had aneurysms larger than 10 mm (82%). Most of the aneurysms were within the anterior circulation (69.2%), six cases of twenty-six (23%) presented ruptured aneurysms. From 22 cases, the preferred treatment modality was endovascular coiling. Two patients died, one directly related to an aneurysm rupture. Conclusion Our analysis shows a possible association between aneurysm size greater than 10 mm and PC occurrence. We concluded that PC may arise as a result of abnormal fluid and vascular dynamics secondary to brain aneurysms that could lead to perivascular changes. Our findings emphasize the lack of uniformity regarding diagnosis and management modalities for this pathology and highlight the need for a standardized approach. Further research is needed for this heterogeneous pathology.

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