We retrospectively analyzed the results of our 16 years of experience in the treatment of unruptured upper basilar artery aneurysms by surgery or coil embolization.
This analysis involved 32 basilar tip aneurysms and 18 basilar superior cerebellar artery bifurcation aneurysms in 19 men and 31 women who ranged in age from 26 to 75 years (mean 57.0 years). Thirty-three aneurysms (66%) were small, 13 (26%) were large, and 4 (8%) were giant. Surgery were performed by 4 selected neurosurgeons and coil embolization was performed by 2 selected endovascular interventionalists. Treatment consisted of aneurysm neck clipping in 24, aneurysm coating in 5, and coil embolization in 21 patients.
Surgery was mainly performed by the transsylvian approach. Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 16 aneurysms (76.2%). Five aneurysms (23.8%) could not be embolized because of anatomic difficulties. In small aneurysms, 24 of the 26 (91.3%) patients treated with surgery remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 7.7% and 0%, respectively. In small aneurysms, 8 of the 9 (88.9%) patients treated with coil embolization remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 11.1% and 0%, respectively. In large aneurysms, the postoperative courses were uneventful in all 3 (100%) patients treated with surgery. There was no procedure-related morbidity or mortality. Eight of the 10 (80%) patients with large aneurysms treated with surgery remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 10% and 10%, respectively. There were 3 poor results (75%) in patients with giant aneurysms, including 1 death caused by premature rupture. One severe disability patient treated with coil embolization died of rebleeding. Four of the 21 patients treated with coil embolization required additional coils because of coil compaction.
Operative results of surgically accessible small aneurysms were satisfactory when patients were treated by selected surgeons. Therapeutic results of coil embolization for small and medium-sized aneurysms were also satisfactory. Aneurysmal neck clipping is superior to coil embolization in therapeutic radicality. Poor results cannot justify the therapeutic indication in every case with asymptomatic unruptured giant BA aneurysms.
