Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

被引:16
|
作者
Jin, Sung-Chul [1 ]
Ahn, Jae Sung [1 ]
Kwun, Byung-Duk [1 ]
Kwon, Do-Hoon [1 ]
机构
[1] Univ Ulsan, Asan Med Ctr, Coll Med, Dept Neurol Surg, Seoul 138736, South Korea
关键词
Aneurysm; Basilar artery; Endovascular; Microsurgery; GUGLIELMI DETACHABLE COILS; WIDE-NECKED ANEURYSMS; RUPTURED INTRACRANIAL ANEURYSMS; POSTERIOR CIRCULATION ANEURYSMS; ARTERY BIFURCATION ANEURYSMS; TIP ANEURYSMS; CEREBRAL ANEURYSMS; UNRUPTURED ANEURYSMS; TECHNICAL NOTE; TRIAL ISAT;
D O I
10.3340/jkns.2009.45.4.224
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective : We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. Methods : Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. Results : Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1%) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery: twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. Conclusion : Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.
引用
收藏
页码:224 / 230
页数:7
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