Abstract
The advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7±14.2years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17±0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1±61.3months proved no recurrences. The best results were observed in patients <65years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.
Highlights
Materials and MethodsPosterior circulation aneurysms have a worse natural history than anterior aneurysms, mainly because of their higher risk of rupture and poor outcome [1]
The aim of this study is a critical appraisal of the overall results of a retrospective surgical series aimed to identify those posterior circulation aneurysms for which microneurosurgery still today maintains a key role
Admission contrast-enhanced computed tomography (CT) angiography was the rule for all patients
Summary
Posterior circulation aneurysms have a worse natural history than anterior aneurysms, mainly because of their higher risk of rupture and poor outcome [1]. This aspect imposes the need for treatment in most cases, especially in younger patients. Exceptions are aneurysms involving the distal segments of the cerebellar arteries, most basilar tip aneurysms, and the giant ones for which microneurosurgery remains a rational option. Clinical onset, the prevalence of site and size, approaches, and outcome of 149 patients surgically treated because they harbored one or more posterior circulation aneurysms have been retrospectively reviewed. Glasgow Outcome Score (GOS) 1 and 2 were considered as “good recovery,” whereas GOS 3, 4, and 5 were considered as “moderate disability,” “severe disability,” and “death-vegetative state,” respectively
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