Surgical or interventional neuroradiological treatment of vertebrobasilar aneurysms?

The study evaluates retrospectively 10 years' experience with the treatment of vertebrobasilar aneurysms in 72 patients. During the last four years in addition to microsurgical methods also interventional neuroradiology was used. From a total number of 72 patients in 19 a vertebrobasilar aneurysm was eliminated from the circulation by GDC coiling and in one instance by means of a stent. In the thus non-selected group of patients the total mortality without differentiation between stages of haemorrhage and the type of therapy was 15.3% (11 patients). 11 pacients (15.3%) had a severe neurological deficit and one patient (1.4%) in stage III-IV was in a vegetative state. Of 31 patients in stage I-Il one patient died. Two patients (6.4%) had a severe neurological deficit. Of 25 patients in stage III-IV 10 patients died (40%) and 8 patients (32%) had a severe neurological deficit. In the group without subarachnoidal haemorrhage the mortality was zero and one patient had a severe neurological deficit. The results of alternative treatment (clipping-endovascular therapy) are not considered worse by the authors than isolated microsurgical treatment. In indicated cases methods of interventional neuroradiology are not only a therapeutic alternative but the only possibility. The two methods are complementary. The extensive elaboration of microneuroanatomy and microsurgical approaches has attained already its peak. This important stage will be followed by the period of an alternative interdisciplinary approach. The presented work respects this trend in the treatment of aneurysms.