Article
Interdisciplinary treatment of vertebral artery and posterior inferior cerebellar artery aneurysms
Die interdisziplinäre Behandlung von Aneurysmen der Arteria vertebralis und Arteria cerebelli inferior posterior
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Published: | April 23, 2004 |
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Outline
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Objective
To describe the clinical results in patients with aneurysms of the vertebral artery and posterior inferior cerebellar artery complex (VA-PICA) treated by endovascular embolization or surgically in cases considered untreatable by endovascular methods.
Methods
During a 5 year period a total of 28 out of 600 patients with a VA-PICA complex aneurysm received definitive treatment in our institution, 19 patients by endovascular embolization and 9 patients surgically. Mean age was 54 years (range 9 - 75 years). Clinical data, intraoperative observations and procedural complications were evaluated. The mean follow-up period was 9 months.
Results
Hunt-Hess (HH) grades were HH 0-II in 10 patients (35.7 %), HH III in 6 patients (21.4 %) and HH IV+V in 12 patients (42.9 %). Aneurysm size ranged from 2 to 40 mm (mean size 5.5 mm). Aneurysm configuration was saccular 17, fusiform 7 and multilobed 3. Complete occlusion was achieved in all cases. Overall 67.9 % (n = 19) showed a favorable outcome (Glasgow Outcome Score IV + V). Overall procedure-related rate for permanent morbidity and mortality was 3.6 % (n = 1) and 3.6 % (n = 1), respectively. Predictive factors of clinical outcome were the initial clinical HH grade (p = 0.01) and the Fisher grade (p = 0.057).
Conclusions
Endovascular embolization is an effective method in the treatment of VA-PICA aneurysms. Surgical clipping is still an alternative for “uncoilable” lesions.