Overall management outcome of ruptured posterior fossa aneurysms

Abstract

A study of the overall management of ruptured posterior fossa aneurysms was conducted over a 1-year period (1993) in five neurosurgical centers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality rate was 27%. Patients with Hunt and Hess Grades I and II had a good overall recovery rate of 87%. On admission, 69% of the patients were assigned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is not warranted in most cases. Frequent devastating rebleeding was observed among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late surgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled for early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements with supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.

Endovascular Treatment of Ruptured Posterior Circulation Cerebral Aneurysms

“…3 The difficulty of treating these aneurysms in the acute phase of SAH is mirrored by the higher rate of complications and morbidity compared with lesions of the anterior circulation. 4 Endovascular treatment of difficult intracranial aneurysms in patients in poor clinical condition has had an increasingly important role in the management of ruptured aneurysms. The recent advent of the Guglielmi electrolytically detachable coil (GDC) has enabled a safer and more controlled form of endovascular therapy.…”

21 Endovascular Treatment of Posterior Circulation Aneurysms

“…They are deeply located, with eloquent perforating arteries and cranial nerves in the immediate vicinity complicated by the small confines of the surgical exposure (MacFarlane et al 1983;Solomon and Stein 1988;Batjer and Samson 1989;Hillman et al 1996). Even after the development of innovative approaches to the skull base and technical improvements (Day et al 1997;Lawton et al 1997;Aziz et al 1999) the morbidity and mortality rates associated with their exposure remain high (Drake 1979;Hernesniemi et al 1992;Hillman et al 1996).…”

“…These and other types of aneurysms of the basilar artery pose challenge to a surgical approach with regards to their location and close relationship with eloquent perforating arteries (Peerless and Drake 1982;MacFarlane et al 1983;Solomon and Stein 1988;Hillman et al 1996). Instead of their location, embolization of aneurysms is rather dependent on their anatomic configuration (Fernandez Zubillaga et al 1994).…”

“…They most often pose challenge to a surgical approach with regards to their location and close relationship with eloquent perforating arteries (Peerless and Drake 1982;MacFarlane et al 1983;Solomon and Stein 1988;Hillman et al 1996). Endovascular treatment of intracranial aneurysms by percutaneous endovascular coil embolization using Guglielmi electrolytically detachable coil (GDC) has been described as an alternative form of treatment with an increasing incidence in the literature (Guglielmi et al 1992;Bavinzski et al 1999;Byrne et al 1999;Lempert et al 2000).…”

“…They are deeply located, with eloquent perforating arteries and cranial nerves in the immediate vicinity complicated by the small confines of the surgical exposure (MacFarlane et al 1983;Solomon and Stein 1988;Batjer and Samson 1989;Hillman et al 1996). Even after the development of innovative approaches to the skull base and technical improvements (Day et al 1997;Lawton et al 1997;Aziz et al 1999) the morbidity and mortality rates associated with their exposure remain high (Drake 1979;Hernesniemi et al 1992;Hillman et al 1996). Endovascular occlusion of intracranial aneurysms using Guglielmi electrolytically detachable coils (GDCs) has been accepted as a valuable therapeutic alternative to surgical clipping of basilar tip aneurysms in patients who were not candidates for surgical intervention because of their presentation in poor condition, advanced age or the difficult nature of their lesion (Guglielmi et al 1992;Peerless et al 1994;Bavinzski et al 1995;Nichols et al 1997;Kuether et al 1998;Bavinzski et al 1999;Byrne et al 1999).…”