Interventional Neurovascular Treatment for Giant Aneurysms of the Posterior Circulation

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Abstract
Interventional neurovascular treatment of giant intracranial aneurysms of the posterior circulation are now being performed in selected cases. Our current indications for therapy include unsuccessful attempt at neurosurgical clipping, surgically inaccessible aneurysms, medically unstable patients who cannot tolerate general anesthesia, and high surgical risk cases. All procedures are performed under local anesthesia, from a transfemoral approach, to monitor the neurological status of the the patient. Fusiform, ectatic aneurysms are treated by test occlusion followed by permanent occlusion of the parent artery utilizing detachable balloons. Aneurysms with a well defined anatomical neck can be approached by placement of silicone balloons, platinum coils with dacron fibers, and/or electrolytic coils into the aneurysm for obliteration.In our entire series of 321 cases, treated by interventional techniques, 79 patients (24.6%) presented with a posterior circulation aneurysm. In this group, 21/79 patients (26.6%) were diagnosed with a giant aneurysm, measuring greater than 2.5cm in diameter. Patient's ranged in age from 10-73 years, and there were 4 males and 17 females. The location of the aneurysm included the distal vertebral artery in 10 cases, mid-basilar artery in 4 cases, distal basilar artery in 5 cases, and the posterior cerebral artery in 2 cases. The presenting symptoms were mass effect in 16/21 cases (76.2%) and subarachnoid hemorrhage in 5/21 cases (23.8%). In 8/21 cases (38.1%), direct occlusion of the aneurysm was achieved, and in 13/21 cases (61.9%) parent vessel occlusion was performed. Complications related to therapy included 4 deaths (19.0%), 2 strokes (9.5%), and 2 patients (9.5%) with transient posterior fossa ischemia.Interventional treatment of giant posterior circulation aneurysms is technically feasible, however it is still associated with significant morbidity and mortality.

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