A comparative analysis of the outcome of surgical clipping and endovascular treatment in the ruptured posterior circulation aneurysms

후순환계 파열성 뇌동맥류에 있어서 결찰술 및 혈관내 치료의 결과분석

Objective : Posterior circulation aneurysms are difficult lesions to treat surgically because they have a potential for high morbidity and mortality. We have used both surgical clipping and endovascular coiling techniques to treat posterior circulation aneurysms and report the comparative results of these two treatment modalities. Method : Of 999 patients with intracranial aneurysms admitted between January 1996 and May 2005, 77 (7.7%) had aneurysms of the posterior circulation. Forty-three cases of posterior circulation aneurysms (43/77 [55.8%]) who were treated with clipping or coiling were included in this study. These aneurysms were located in the following sites: 20 cases (46.5%) in the basilar bifurcation artery (BBA), 9 cases (20.9%) in the superior cerebellar artery (SCA), 7 cases (16.7%) in the vertebral artery (VA), 4 cases (9.5%) in the distal posterior inferior cerebellar artery (PICA), and 4 cases (9.5%) in the posterior cerebral artery (PCA). Fourteen (31%) aneurysms were treated with surgical clipping and 29 (69%) aneurysms were treated with endovascular coiling. The treatment outcomes from outpatient follow-up 12 months after treatment were analyzed according to Glasgow outcome scale (GOS). Result : Overall, 10 patients who were treated with surgical clipping and 22 (74.4%) patients who were treated with endovascular therapy had good outcomes (GOS, 4~5). The mortality of surgical treatment and endovascular coiling was approximately 7.1% (1/14) and 6.9% (2/29), respectively. The postoperative complications included two transient cranial nerve deficits in the patients who underwent surgical treatment, whereas the patients who underwent endovascular treatment had more serious complications (two intra-operative aneurysm ruptures and three embolic infarctions). Conclusion : Patients treated with endovascular coiling had more severe intra-procedure rebleeding than patients treated with surgical clipping; however, there was no statistical significant difference in overall outcome between the two treatment groups. Both surgical and endovascular approaches to posterior circulation aneurysms can achieve good outcomes, and appropriate choice depends on the judgment of the surgeon and neurointerventionist based on angiographic findings. More cautious judgment according to patient factors and angiographic findings can improve the final results.