Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation

View More View Less
  • 1 Departments of Radiology and Neurosurgery, Hôpital Notre-Dame, Montreal, Quebec, Canada; and Department of Neurosurgery, Hôpital du Sacré-Coeur, Montreal, Quebec, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The surgical treatment of basilar bifurcation aneurysms is difficult and the need for an alternative approach is frequently stated. To assess the efficacy and safety of endovascular treatment of aneurysms located at the basilar bifurcation, the authors prospectively studied angiographic results, clinical results, and complications in 31 patients treated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS).

There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patients; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. The GOS score for the group of patients treated acutely was: GOS I, 18 patients; GOS II, III, and IV, one patient each; and GOS V, two patients. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treatment and one had residual diplopia at 4 months. Eight patients were treated for incidental basilar bifurcation aneurysms. One technical complication with no neurological deficit occurred in this group of patients with incidental aneurysms.

Immediate angiographic results were considered to be satisfactory in 94% of patients, with complete obliteration in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging from 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiographic results were available for 27 patients at 6 months and were as follows: 30% of the lesions were completely obliterated, 59% presented some residual neck, and 11% showed some opacification of the aneurysm sac. During the follow-up period of up to 42 months, a total of seven recurrences were noted, necessitating retreatment with GDCs in five patients.

Endovascular treatment of basilar bifurcation aneurysms prevented rebleeding and could be performed without clinically significant complications in 94% of patients. Clinical results after SAH compared favorably with surgical series. Morphological results appear less satisfactory, and long-term angiographic follow-up review is mandatory to detect recurrences.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Jean Raymond, M.D., Department of Radiology, Hôpital Notre-Dame, 1560 Sherbrooke Street East, Montréal, Québec, H2L 4M1 Canada.
  • 1.

    Batjer HH, & Samson DS: Causes of morbidity and mortality from surgery of aneurysms of the distal basilar artery. Neurosurgery 25:904916, 1989 Batjer HH, Samson DS: Causes of morbidity and mortality from surgery of aneurysms of the distal basilar artery. Neurosurgery 25:904–916, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Casasco AE, , Aymard A, & Gobin YP, et al. : Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:310, 1993 Casasco AE, Aymard A, Gobin YP, et al: Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. J Neurosurg 79:3–10, 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    Chavis TD, & Hopkins LN: Comment on Graves VB, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:647648, 1995 Chavis TD, Hopkins LN: Comment on Graves VB, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:647–648, 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Civit T, , Auque J, & Marchal JC, et al. : Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 38:955961, 1996 Civit T, Auque J, Marchal JC, et al: Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 38:955–961, 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96144, 1979 Drake CG: The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26:96–144, 1979

    • Search Google Scholar
    • Export Citation
  • 6.

    Fernandez Zubillaga A, , Guglielmi G, & Viñuela F, et al. : Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815820, 1994 Fernandez Zubillaga A, Guglielmi G, Viñuela F, et al: Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR 15:815–820, 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Feuerberg I, , Lindquist C, & Lindqvist M, et al. : Natural history of postoperative aneurysm rests. J Neurosurg 66:3034, 1987 Feuerberg I, Lindquist C, Lindqvist M, et al: Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34, 1987

    • Search Google Scholar
    • Export Citation
  • 8.

    Graves VB, , Strother CM, & Duff TA, et al. : Early treatment of ruptured aneurysms with Guglielmi detachable coils: Effect on subsequent bleeding. Neurosurgery 37:640647, 1995 Graves VB, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: Effect on subsequent bleeding. Neurosurgery 37:640–647, 1995

    • Search Google Scholar
    • Export Citation
  • 9.

    Graves VB, , Strother CM, & Rappe AH: Treatment of experimental canine carotid aneurysms with platinum coils. AJNR 14:787793, 1993 Graves VB, Strother CM, Rappe AH: Treatment of experimental canine carotid aneurysms with platinum coils. AJNR 14:787–793, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Guglielmi G, , Viñuela F, & Dion J, et al. : Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:814, 1991 Guglielmi G, Viñuela F, Dion J, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Guglielmi G, , Viñuela F, & Duckwiler G, et al. : Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515524, 1992 Guglielmi G, Viñuela F, Duckwiler G, et al: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Guglielmi G, , Viñuela F, & Sepetka I, et al. : Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:17, 1991 Guglielmi G, Viñuela F, Sepetka I, et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:1–7, 1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Gurian JH, , Martin NA, & King WA, et al. : Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83:843853, 1995 Gurian JH, Martin NA, King WA, et al: Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 83:843–853, 1995

    • Search Google Scholar
    • Export Citation
  • 14.

    Hernesniemi J, , Vapalahti M, & Niskanen M, et al. : Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:857861, 1992 Hernesniemi J, Vapalahti M, Niskanen M, et al: Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:857–861, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Heros RC: Comment on Graves V, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:648, 1995 Heros RC: Comment on Graves V, Strother CM, Duff TA, et al: Early treatment of ruptured aneurysms with Guglielmi detachable coils: effect on subsequent bleeding. Neurosurgery 37:648, 1995

    • Search Google Scholar
    • Export Citation
  • 16.

    Higashida RT, , Halbach VV, & Barnwell SL, et al. : Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633642, 1990 Higashida RT, Halbach VV, Barnwell SL, et al: Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. AJNR 11:633–642, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Higashida RT, , Halbach VV, & Cahan LD, et al. : Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. J Neurosurg 71:512519, 1989 Higashida RT, Halbach VV, Cahan LD, et al: Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. J Neurosurg 71:512–519, 1989

    • Search Google Scholar
    • Export Citation
  • 18.

    Hunt WE, & Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:1420, 1968 Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968

    • Search Google Scholar
    • Export Citation
  • 19.

    Kassell NF, , Torner JC, & Haley EC Jr, et al. : The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:1836, 1990 Kassell NF, Torner JC, Haley EC Jr, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Kassell NF, , Torner JC, & Jane JA, et al. : The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:3747, 1990 Kassell NF, Torner JC, Jane JA, et al: The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:37–47, 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Lin T, , Fox AJ, & Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556560, 1989 Lin T, Fox AJ, Drake CG: Regrowth of aneurysm sacs from residual neck following aneurysm clipping. J Neurosurg 70:556–560, 1989

    • Search Google Scholar
    • Export Citation
  • 22.

    Macdonald RL, , Wallace MC, & Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:826832, 1993 Macdonald RL, Wallace MC, Kestle JRW: Role of angiography following aneurysm surgery. J Neurosurg 79:826–832, 1993

    • Search Google Scholar
    • Export Citation
  • 23.

    Mawad ME, , Mawad JK, & Cartwright J Jr, et al. : Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR 16:713, 1995 Mawad ME, Mawad JK, Cartwright J Jr, et al: Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR 16:7–13, 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    McDougall CG, , Halbach VV, & Dowd CF, et al. : Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393399, 1996 McDougall CG, Halbach VV, Dowd CF, et al: Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84:393–399, 1996

    • Search Google Scholar
    • Export Citation
  • 25.

    Peerless SJ: Comment on Hernesniemi J, Vapalahti M, Niskanen M, et al: Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:861862, 1992 Peerless SJ: Comment on Hernesniemi J, Vapalahti M, Niskanen M, et al: Management outcome for vertebrobasilar artery aneurysms by early surgery. Neurosurgery 31:861–862, 1992

    • Search Google Scholar
    • Export Citation
  • 26.

    Peerless SJ, , Hernesniemi JA, & Gutman FB, et al. : Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg 80:643649, 1994 Peerless SJ, Hernesniemi JA, Gutman FB, et al: Early surgery for ruptured vertebrobasilar aneurysms. J Neurosurg 80:643–649, 1994

    • Search Google Scholar
    • Export Citation
  • 27.

    Peerless SJ, , Nemoto S, & Drake CG: Acute surgery for ruptured posterior circulation aneurysms. Adv Tech Stand Neurosurg 15:115129, 1987 Peerless SJ, Nemoto S, Drake CG: Acute surgery for ruptured posterior circulation aneurysms. Adv Tech Stand Neurosurg 15:115–129, 1987

    • Search Google Scholar
    • Export Citation
  • 28.

    Pierot L, , Boulin A, & Castaings L, et al. : Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:948954, 1996 Pierot L, Boulin A, Castaings L, et al: Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:948–954, 1996

    • Search Google Scholar
    • Export Citation
  • 29.

    Rice BJ, , Peerless SJ, & Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165173, 1990 Rice BJ, Peerless SJ, Drake CG: Surgical treatment of unruptured aneurysms of the posterior circulation. J Neurosurg 73:165–173, 1990

    • Search Google Scholar
    • Export Citation
  • 30.

    Sugita K, , Kobayashi S, & Shintani A, et al. : Microneurosurgery for aneurysms of the basilar artery. J Neurosurg 51:615620, 1979 Sugita K, Kobayashi S, Shintani A, et al: Microneurosurgery for aneurysms of the basilar artery. J Neurosurg 51:615–620, 1979

    • Search Google Scholar
    • Export Citation
  • 31.

    Troupp H: The natural history of aneurysms of the basilar bifurcation. Acta Neurol Scand 47:350356, 1971 Troupp H: The natural history of aneurysms of the basilar bifurcation. Acta Neurol Scand 47:350–356, 1971

    • Search Google Scholar
    • Export Citation
  • 32.

    Yaşargil MG: Vertebrobasilar aneurysms, in Yaşargil MG (ed): Microneurosurgery II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. New York: Thieme Stratton, 1984, pp 232295 Yaşargil MG: Vertebrobasilar aneurysms, in Yaşargil MG (ed): Microneurosurgery II. Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. New York: Thieme Stratton, 1984, pp 232–295

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 511 117 11
Full Text Views 186 17 1
PDF Downloads 70 6 1
EPUB Downloads 0 0 0