A comparison between endovascular and surgical management of basilar artery apex aneurysms

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Object. The goal of this retrospective study was to evaluate endovascular treatment by means of Guglielmi detachable coils (GDCs) compared with surgical management for basilar artery (BA) apex aneurysms.

Methods. Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treatment. Of 20 patients who underwent surgery and 21 who underwent GDC embolization, 15 (75%) and 11 (52%), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty-four (92%) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen patients with unruptured or ruptured aneurysms more than 14 days post-SAH were treated electively. Patients in the endovascular and surgical treatment groups had aneurysms with comparable dimensions and configurations. Overall, 15 (75%) of the surgical patients and 20 (95%) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAH, 11 (73%) of the surgical group and 10 (91%) of the endovascular group did well. Fourteen patients treated electively (93%) had good outcomes. There were two deaths (10%) in the surgical group and none in the endovascular group. Patients treated surgically were hospitalized twice as long and incurred twice the expenses of patients who underwent endovascular treatment (p < 0.001).

Conclusions. Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long-term follow up is needed to better define the natural history of the endovascularly treated aneurysm and to further evaluate the accuracy of these preliminary results.

Article Information

Address reprint requests to: John M. Tew, Jr., M.D., c/o Editorial Office, Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Bethesda Avenue, P.O. Box 670515, Cincinnati, Ohio 45267–0515.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Angiograms obtained in the seven patients who were excluded from the study. The morphological characteristics present in these patients' aneurysms were thought to make GDC embolization difficult or risky, and they were therefore treated with surgical clipping.

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    Graph showing comparison between GDC embolization and aneurysm neck size. The values on the vertical axis represent the percentage of aneurysm filling.

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    Chart showing algorithm for prospective management protocol for patients with BA aneurysms.

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