Posterior Circulation Aneurysms: A Critical Appraisal of a Surgical Series in Endovascular Era

Abstract

The advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28 years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7 ± 14.2 years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17 ± 0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1 ± 61.3 months proved no recurrences. The best results were observed in patients <65 years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.

Treatment of vertebrobasilar system aneurysms: a surgical dead end? — comment on Szmygin et al., Polish Journal of Neurology and Neurosurgery, 2021

“…Certainly, the advantages of the coiling procedure in the vertebrobasilar area have been clearly delineated by several analyses, including the publication under discussion here. However, recent advances in microsurgical techniques of neurovascular procedures, including endoscopic visualisation [13][14][15] and bypass techniques [16,17] still allow an appreciation of the microsurgical treatment of posterior circulation aneurysms to be either a crucial amendment, or a valid competitive therapy, to endovascular procedures [18][19][20], with success rates of 88% [21,22] up to 98% [19] (in a series of 217 surgical patients reported by Sansai et al). This option is of great value especially if for any reason coiling or flow diversion seem to carry a lower chance of success than expected, e.g.…”