Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

Abstract

Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

Regrowth and Fatal Rerupture Despite Proximal Occlusion After Coil Embolization of a Ruptured Large Basilar Bifurcation Aneurysm-Case Report-

“…However, early postoperative thromboembolic brainstem ischemia within a week could develop and the mass effect might persist despite complete thrombosis of the aneurysm. 8) Our case suggests that upper BA occlusion does not guarantee prevention of rebleeding or regrowth of the giant basilar bifurcation aneurysm containing a large coil mass and thrombus. GDC treatment may secure a ruptured large or giant basilar bifurcation aneurysm in the short term, but does not provide adequate long-term protection without further intervention.…”

“…GDC treatment may secure a ruptured large or giant basilar bifurcation aneurysm in the short term, but does not provide adequate long-term protection without further intervention. 1,9) At present, direct surgical clipping using a skull base technique with or without hypothermic circulatory arrest 7) or upper BA occlusion with or without bypass surgery 8) may be a better choice as an initial treatment for giant or large basilar bifurcation aneurysm with a wide neck.…”

Giant partially thrombosed aneurysm of the vertebral artery: a case report and literature review

“…Steinberg и соавт. [28] показали, что у пациен-тов с гигантскими аневризмами ПА полный тром-боз аневризм наблюдается в 87% случаев после проксимальной окклюзии несущего сосуда с умень-шением имеющихся неврологических расстройств. При неполном тромбозе гигантских аневризм в 67% случаев отмечалось нарастание неврологических выпадений, которые у 86% оказались смертельны-ми.…”

Occipitoaxial spinal interarticular stabilization with vertebral artery preservation for atlantal lateral mass failure

“…The risk of neurological deficit following VA sacrifice is reported as 6% in the literature. 18 In our 2 cases we performed an intralesional resection with preservation of the VA by transposing it out of the direct surgical field. This avoids the risk of ischemic stroke, as mentioned above, and enables unrestricted instrumentation of C-2, which would be contraindicated on the side opposite to an occluded VA.…”