Results of Microsurgical Clipping of 50 High Complexity Basilar Apex Aneurysms

Krisht, Ali F.; Krayenbühl, Niklaus; Sercl, David; Bikmaz, Kerem; Kadri, Paulo A S

doi:10.1227/01.neu.0000249265.88203.df

Cited by 98 publications

(54 citation statements)

References 56 publications

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“…This may be due to the greater durability of microsurgery compared with embolization. A previous study reported that clipping was successful in 95% of patients with complex basilar top aneurysms, with no evidence of residual aneurysms on follow-up angiography provided 14,15) . Radiological complete occlusion of basilar apex aneurysms in our series was relatively worse than previous report.…”

Section: Features Of Microsurgical Clippingmentioning

confidence: 96%

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

Jin

Ahn

Kwun

et al. 2009

J Korean Neurosurg Soc

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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.

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Section: Features Of Microsurgical Clippingmentioning

confidence: 96%

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

Jin

Ahn

Kwun

et al. 2009

J Korean Neurosurg Soc

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“…Their higher morbidity has encouraged different surgical and endovascular approaches; nevertheless, treatment is still fraught with limitations, especially intraoperative and postoperative morbidity and, with endovascular methods, high rates of incomplete occlusion and late reopening 1,2,3,4,5,6,7,8,9,10 . Several series have reported the outcomes of patients undergoing surgical or endovascular treatment of basilar aneurysms 9,27 .…”

Section: Basilar Artery Aneurysms Account For Approximately 7%mentioning

confidence: 99%

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

Pahl

Oliveira

Rotta

2017

Arq. Neuro-Psiquiatr.

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Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

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“…5 Krisht et al presented their impressive experience with 50 complex basilar aneurysms managed through a pretemporal, transzygomatic transcavernous approach. 6 These aneurysms, unamenable to endovascular coiling, were successfully clipped in 98% of cases with no procedure-related mortality and 6-month follow-up Rankin scores of 0 to 2 in 92% of patients. Given that half of the patients in this series presented with subarachnoid hemorrhage, this is a truly remarkable contrast to the 30.9% death or dependence rate at 1 year reported by ISAT for clipping of ruptured, predominantly small anterior circulation aneurysms.…”

Section: Aneurysmsmentioning

confidence: 87%