SACCULAR ANEURYSMS OF THE VERTEBRAL-BASILAR ARTERIAL SYSTEMA Report of 28 Cases

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Abstract
A series of 28 saccular aneurysms of the vertebral-basilar arterial system, 24 ruptured and 4 non-ruptured is presented. The patients were followed up for an average 3 years after discharge. The average age on admission was 46 years. In the great majority of cases, the hemorrhage had an acute onset without prodromal symptoms. Focal neurological signs indicating localization of the aneurysm to the posterior cerebral fossa were present in only 8 cases. In 11 cases no focal neurological signs were observed. In 1 case, the aneurysm of the vertebral-basilar system was combined with an aneurysm of 1 of the coronary arteries of the heart. In 1 case in which angiographic examinations were made at an interval of 4 years, the aneurysm and its hemorrhagic cavity were found to have become considerably larger, producing increasingly severe symptoms of compression of the peduncles. The diagnosis was established or verified in 17 cases by angiography, in 10 cases at autopsy, and in 1 case at operation. When bilateral carotid angiography is negative in a case of subarachnoid hemorrhage, the examination should be supplemented by vertebral angiography, preferably bilateral. Five patients died within the first 2 weeks of the last hemorrhage, and another 4 before the end of the 7th week of a recurrent hemorrhage. Another patient with a non-ruptured aneurysm died on the 4th day after admission to the hospital. No operation was performed in these 10 cases. Operation was performed on 12 patients; 8 of them were alive when the follow-up study was made. Two had died of another disease during the observation period, and 1 (possibly 2) of a recurrent subarachnoid hemorrhage. Operation seems to be indicated as soon as a patient has recovered from the immediate consequence of the hemorrhage.

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