Retrospective Study of 32 Kissing Aneurysms: Radiological Detection, Microsurgical Clipping, and Functional Outcomes

INTRODUCTION: Kissing aneurysms (KA) are a rare variant of multiple intracranial aneurysms characterized by two adjacent aneurysms arising from separate vascular origins with adherent domes. Their atypical morphology often leads to misinterpretation as a single bilobulated aneurysm, which complicates diagnosis and surgical planning. Preoperative distinction between the aneurysms is especially crucial when rupture occurs. This study aimed to analyze the clinical, radiological, and surgical characteristics of 32 patients with KA treated microsurgically over two decades and provide a narrative review of the literature to contextualize our findings. METHODS: A retrospective observational study was conducted on patients diagnosed with KA and treated by microsurgical clipping between January 2004 and October 2024. Imaging modalities included computed tomography (CT), CT angiography, and digital subtraction angiography. Microsurgical approaches were tailored to aneurysm location and rupture status. Functional outcomes were assessed using the modified Rankin scale (mRS). RESULTS: KA accounted for 2.3% of all aneurysms treated during the study period. The most frequent site was the posterior communicating artery-anterior choroidal artery segment (59.37%). Preoperative identification of KA was achieved in 87.5% of cases. Intraoperative rupture occurred in 25%. Favorable outcomes (mRS 0-2) were observed in 87.5% of patients. Surgical approach selection, vascular control, and intraoperative Doppler guidance were critical to success. DISCUSSION: KA remains a diagnostic challenge, with a portion of cases confirmed only intraoperatively. Microsurgical clipping of these complex lesions requires precise dissection, temporary vascular control, and intraoperative vascular imaging to ensure complete occlusion and vessel preservation. Age appears to be a risk factor for rupture, underscoring the need for vigilant monitoring in older patients. CONCLUSION: Kissing aneurysms remain a diagnostic and surgical challenge due to their complex anatomy and high rupture risk. Accurate imaging, individualized surgical planning, and intraoperative vessel assessment are essential to optimize outcomes.