Traumatic Pericallosal Artery Aneurysms: A Systematic Review of Clinical Presentation, Treatment, and Outcomes

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Abstract
Traumatic pericallosal artery aneurysms (TPAAs) are a rare but potentially fatal subset of intracranial aneurysms, typically resulting from blunt or penetrating head trauma. Located along the distal anterior cerebral artery (DACA), their deep midline position and proximity to the falx render them vulnerable to shear injury, technically challenging to diagnose and treat. They often present as pseudoaneurysms with a high risk of delayed rupture. We conducted a systematic review of studies published between 1995 and April 2025 using PubMed and Google Scholar. Included studies described pericallosal or DACA traumatic aneurysms and reported clinical, radiological, and outcome data. Extracted variables included patient demographics, mechanism of injury, diagnostic modality and timing, aneurysm characteristics, treatment type, and outcomes. Statistical analysis assessed predictors of neurological prognosis using the Glasgow Outcome Scale. Fifty-eight patients from 44 studies met the inclusion criteria. Blunt trauma was the most common cause (62.1%). Aneurysms were more frequently right-sided (69%), and nearly half were diagnosed within 2 weeks postinjury. Endovascular (39.7%) and microsurgical (55.2%) treatments were both commonly employed, while conservative management was rare (3.4%). No significant outcome differences were found between treatment modalities. Poorer outcomes were significantly associated with aneurysm rupture ( p < 0.01) and older age ( p ≈ 0.02), while laterality and trauma mechanism were not. Pediatric patients demonstrated more favorable outcomes. In conclusion, TPAAs are rare but clinically urgent lesions. Early vascular imaging and timely intervention are essential. Prognosis depends more on rupture status and patient age than on treatment modality. Standardized outcome reporting is needed to guide management.

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