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Cent Eur Neurosurg 2005; 66(1): 9-16
DOI: 10.1055/s-2004-836224
Original Article

© Georg Thieme Verlag Stuttgart · New York

Endovascularly or Surgically Treated Vertebral Artery and Posterior Inferior Cerebellar Artery Aneurysms: Clinical Analysis and Results

Endovaskulär oder operativ behandelte Aneurysmen der Arteria vertebralis und Arteria cerebelli inferior posterior: Eine klinische Analyse und ErgebnisseI. E. Sandalcioglu1 , I. Wanke2 , B. Schoch1 , T. Gasser1 , J. P. Regel1 , A. Doerfler2 , M. Forsting2 , D. Stolke1
  • 1Department of Neurosurgery, University of Essen, Germany
  • 2Department of Neuroradiology, University of Essen, Germany
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Publication History

Publication Date:
02 March 2005 (online)

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Abstract

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. Patients and Methods: During a 5-year-period a total of 28 patients with a VA-PICA complex aneurysm out of 600 patients received definitive treatment, 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 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 18, 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 and the Fisher grade. Conclusion: Endovascular embolization is an effective method for the treatment of VA-PICA aneurysms. Surgical clipping is still an alternative and should be considered for “uncoilable” lesions. Outcomes showed a close correlation to the initial clinical state and were not dependent on the treatment modality.

Zusammenfassung

Zielsetzung: Über die klinischen Ergebnisse von Patienten mit einem Aneurysma der Arteria vertebralis (VA) und Arteria cerebelli posterior inferior (PICA) zu berichten, die entweder endovaskulär oder chirurgisch behandelt wurden. Patienten und Methode: In einer 5-Jahres-Periode wurden 28 Patienten mit einem Aneurysma der VA oder der PICA aus insgesamt 600 Patienten mit zerebralen Aneurysmen in unserer Klinik behandelt. Neunzehn wurden endovaskulär und 9 chirurgisch behandelt. Das durchschnittliche Alter betrug 54 Jahre (9-75 Jahre). Die klinischen Daten, intraoperative Ereignisse und prozedurale Komplikationen wurden retrospektiv ausgewertet. Die mittlere Nachbeobachtungszeit betrug 9 Monate. Ergebnisse: Die Hunt und Hess (HH) Grade waren: HH 0-II bei 10 (35,7 %), HH III bei 6 (21,4 %) und HH IV + V bei 12 Patienten (42,9 %). Die Aneurysmagröße variierte von 2-40 mm (mittlere Größe 5,5 mm). Die Aneurysma-Konfiguration war sakkulär in 18, fusiform in 7 und multilobulär in 3 Fällen. In allen Fällen war ein kompletter Verschluss des Aneurysmas möglich. In 67,9 % der Fälle wurde ein gutes Outcome erzielt (Glasgow Outcome Score IV + V). Die Morbiditäts- und Mortalitätsrate betrug 3,6 % (n = 1) bzw. 3,6 % (n = 1) für das gesamte Patientenkollektiv. Der initiale klinische HH Grad und der Fisher Grad erwiesen sich als prädiktive Faktoren für das Outcome. Schlussfolgerung: Die endovaskuläre Therapie ist eine effektive Methode in der Behandlung von VA-PICA Aneurysmen. Die chirurgische Behandlung ist weiterhin eine Behandlungsalternative in nicht „coilbar” eingestuften Läsionen. Das Behandlungsergebnis zeigt eine enge Korrelation zum initialen klinischen Status und keine Abhängigkeit zur Therapiemodalität.

Key words

Cerebral aneurysms - vertebral artery - posterior inferior cerebellar artery - endovascular therapy - aneurysm surgery

Schlüsselwörter

Zerebrale Aneurysmen - Arteria vertebralis - Arteria cerebelli inferior posterior - endovaskuläre Therapie - Aneurysma-Chirurgie

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Dr. I. E. Sandalcioglu

Department of Neurosurgery · University of Essen

Hufelandstr. 55

45122 Essen

Germany

Phone: + 49/2 01/7 23 12 01

Fax: + 49/2 01/7 23 59 09

Email: sandalcioglu@uni-essen.de

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