Abstract
Together with current advances in neuroimaging techniques, the chance for incidental discovery of unruptured cerebral aneurysms has greatly increased, and the selection of their appropriate management remains controversial, especially for the unruptured aneurysms arising from the posterior circulation. To provide current data about the management for such patients with unruptured vertebrobasilar artery aneurysms, we reviewed 36 consecutive patients with such aneurysms treated either by surgical or conservative means. Sixteen patients were treated surgically. Twelve aneurysms (including 5 large or giant aneurysms) were clipped, and the remaining 4 aneurysms (2 giant aneurysms and 2 vertebral artery aneurysms) were treated by the endovascular approach. There were no surgical mortality but 2 poor results in this series. These 2 poor outcomes were attributable to perforator vessel injuries during direct clipping of the large basilar bifurcation aneurysms. Twenty patients were managed conservatively. Three (15%) of the 20 conservatively managed patients died from the aneurysm rupture during the follow-up period, which averaged 4.6 years. It was confirmed, however, that none of the 7 tiny aneurysms smaller than 5mm in diameter had ruptured. The authors conclude that the unruptured aneurysms of posterior circulation should be considered for surgical treatment, if the aneurysm can easily be approached surgically and the patient's age and medical conditions do not contraindicate surgery. Even for surgically high-risk patients with the giant aneurysms of posterior circulation aneurysms, the surgical indications are now being expanded with the development of the neurosurgical and endovascular surgical techniques.
