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Bypass and Flow Reduction for Complex Basilar and Vertebrobasilar Junction Aneurysms

Kalani, M. Yashar S. MD, PhD; Zabramski, Joseph M. MD; Nakaji, Peter MD; Spetzler, Robert F. MD

doi: 10.1227/NEU.0b013e3182870703
Research-Human-Clinical Studies

BACKGROUND: Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat.

OBJECTIVE: To evaluate the long-term outcomes of patients with vertebrobasilar aneurysms treated with extracranial-intracranial bypass and flow reduction.

METHODS: We retrospectively reviewed a prospective database of aneurysms cases treated between December 1993 and August 2011.

RESULTS: Eleven patients (8 male, 3 female) with 12 aneurysms were treated. There were 3 basilar apex aneurysms, 2 aneurysms of the basilar trunk, and 7 vertebrobasilar junction aneurysms. There were 5 saccular and 7 fusiform aneurysms. All patients underwent extracranial-intracranial bypass and vessel occlusion. Flow was reversed or reduced by complete (n = 6) or partial occlusion of the basilar artery (n = 3) or by occlusion of the vertebral arteries distal to the posterior inferior cerebellar artery (n = 3). Postoperatively (mean follow-up, 71.6 months; range, 4-228; median, 49 months), the bypass patency rate was 92.3% (12/13). The perioperative mortality rate for the initial treatment was 18.2% (2/11). In 4 cases, the aneurysms continued to grow and required further treatment; after re-treatment, 3 of these patients died. Of the initial 11 patients, 6 were treated successfully and 5 died. The mean preoperative modified Rankin Scale score was 2.1 (range, 1-3; median, 2). At last follow-up for all patients, the mean modified Rankin Scale score was 3.45 (range, 1-6; median, 3) and 2.5 (range, 1-4; median, 2.5) for the 6 long-term survivors.

CONCLUSION: Vertebrobasilar aneurysms are challenging lesions with limited microsurgical or endovascular options. Despite aggressive surgical treatment, the long-term outcome remains poor for most patients.

ABBREVIATIONS: EC-IC, extracranial-intracranial

mRS, modified Rankin Scale

PCA, posterior cerebellar artery

PICA, posterior inferior cerebellar artery

SCA, superior cerebellar artery

STA, superficial temporal artery

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Correspondence: Robert F. Spetzler, MD, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013. E-mail:

Received September 10, 2012

Accepted December 25, 2012

Copyright © by the Congress of Neurological Surgeons