Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms
- 1 August 1993
- journal article
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 79 (2) , 161-173
- https://doi.org/10.3171/jns.1993.79.2.0161
Abstract
Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.Keywords
This publication has 35 references indexed in Scilit:
- Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysmsJournal of Neurosurgery, 1991
- Therapeutic Occlusion of the Vertebral Artery for Unclippable Vertebral Aneurysm: Relationship between Site of Occlusion and Clinical OutcomeNeurosurgery, 1984
- Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literatureSurgical Neurology, 1984
- Vertebrobasilar occlusion therapy of giant aneurysmsJournal of Neurosurgery, 1984
- Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome.Stroke, 1979
- Basilar artery occlusion: clinical and radiological correlation.Stroke, 1977
- Spontaneous thrombosis in agiant middle cerebral artery aneurysmJournal of Neurosurgery, 1972
- THE CIRCLE OF WILLIS—THE INCIDENCE OF DEVELOPMENTAL ABNORMALITIES IN NORMAL AND INFARCTED BRAINSBrain, 1967
- Ligation of Basilar Artery in Treatment of an Aneurysm at the Basilar-Artery BifurcationJournal of Neurosurgery, 1962