Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients
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CLINICAL ARTICLE - VASCULAR
Surgical management of vertebral and basilar artery aneurysms: a single center experience in 41 patients Xiang'en Shi & Hai Qian & K. C. K. I. Singh & Yongli Zhang & Zhongqing Zhou & Yuming Sun & Fangjun Liu
Received: 22 October 2012 / Accepted: 18 February 2013 / Published online: 8 March 2013 # Springer-Verlag Wien 2013
Abstract Objective To study an effective method for surgical management of vertebral and basilar artery aneurysms. Methods Forty-one patients with 43 aneurysms of the vertebral and basilar arteries were managed by microsurgical clipping. Cerebral angiography revealed basilar apex aneurysms in 17 patients, basilar trunk in six patients, vertebrobasilar (VB) junction aneurysms in three patients and vertebral aneurysms in 15 patients. One patient had two basilar aneurysms, and another had bilateral vertebral artery aneurysm. Surgical technique We used a pterional approach in basilar apex aneurysms (n=17 patients), orbitozygomatic and its variants in upper basilar trunk aneurysms (n=2 patients), combined petrosal and far-lateral approach in mid basilar trunk aneurysms (n=4 patients), far-lateral and transcondylar approach for the aneurysms at VB junction (n=3 patients) and transcondylar approach for the vertebral aneurysms (n=15 patients). Bypass graft was performed in 14 patients with This work was supported by the grant: Capital Medicine Development (Specialization) Foundation of China (Z2011-7011-02;121107001012061) X. Shi Department of Neurosurgery, Affiliated Fuxing Hospital, The Capital University of Medical Sciences, Beijing, China 100038 X. Shi (*) : H. Qian : Y. Zhang : Z. Zhou : Y. Sun : F. Liu Department of Neurosurgery, Beijing Sanbo Brain Hospital, No. 50 Yikesong Rd, Haidian District, Beijing, China 100093 e-mail: [email protected] K. C. K. I. Singh National Neurosurgical Referral Centre, Bir Hospital, Kathmandu, Nepal
fusiform and wide neck aneurysms, to prevent potential cerebral ischemia due to prolonged temporary occlusion or possibility of intraoperative parent artery sacrifice. Results Neurological outcomes were measured on the basis of Glasgow Outcome Score (GOS). The rate of back-to-normal life after surgery in basilar tip aneurysm, basilar trunk aneurysms, VB junction aneurysms and vertebral artery aneurysms was 15/17 (82.5 %), 5/6 (83 %), 3/3 (100 %) and 14/15 (93.3 %), respectively. Thirty-six (87.8 %) patients had uneventful postoperative courses. Two patient with basilar apex aneurysm suffered severe neurological deficits related to midbrain ischemia, two patient with occipital artery (OA) graft bypass had postoperative partial lower cranial nerve palsy, and one death with basilar trunk aneurysm occurred after the 20th day of surgery. Thirty-nine patients accepted postoperative digital subtraction angiography (DSA) and eight patients accepted computed tomography (CT) angiogram, whereas two patient denied either one. All the images demonstrated afferent and efferent vessels without aneurysm in situ. Out of 14 patients with graft bypass, 11 patients
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