DOI QR코드

DOI QR Code

Analysis of Clinical and Radiological Outcomes in Microsurgical and Endovascular Treatment of Basilar Apex Aneurysms

  • Jin, Sung-Chul (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ahn, Jae-Sung (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwun, Byung-Duk (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwon, Do-Hoon (Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center)
  • 발행 : 2009.04.28

초록

Objective : We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. Methods : Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. Results : Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1 %) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery : twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. Conclusion : Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.

키워드

참고문헌

  1. Akiba Y, Murayama Y, Vinuela F, Lefkowitz MA, Duckwiler GR, Gobin YP : Balloon-assisted Guglielmi detachable coiling of widenecked aneurysms: Part I--experimental evaluation. Neurosurgery 45 : 519-527; discussion 527-530, 1999 https://doi.org/10.1097/00006123-199909000-00022
  2. Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JI : The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms : experience at the University of Illinois at Chicago. J Neurosurg 93 : 388-396, 2000 https://doi.org/10.3171/jns.2000.93.3.0388
  3. Batjer HH, Samson DS : Causes of morbidity and mortality from surgery of aneurysms of the distal basilar artery. Neurosurgery 25 : 904-916, 1989 https://doi.org/10.1227/00006123-198912000-00009
  4. Bavinzski G, Killer M, Gruber A, Reinprecht A, Gross CE, Richling B : Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils : a 6-year experience. J Neurosurg 90 : 843-852, 1999 https://doi.org/10.3171/jns.1999.90.5.0843
  5. Byrne JV, Guglielmi G : Endovacular Treatment of Intracranial Aneurysms. Berlin : Springer-Verlag, 1998
  6. Cloft HJ, Joseph GJ, Tong FC, Goldstein JH, Dion JE : Use of threedimensional Guglielmi detachable coils in the treatment of widenecked cerebral aneurysms. AJNR Am J Neuroradiol 21 : 1312-1314, 2000
  7. Drake CG : Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg 18 : 230-238, 1961 https://doi.org/10.3171/jns.1961.18.2.0230
  8. Drake CG, Peerless SJ, Hernesniemi JA : Surgery of Vertebrobasilar Aneurysms : London, Ontario Experience on 1767 Patients. Vienna, Springer-Verlag, 1996
  9. Eskridge JM, Song JK : Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils : results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 89 : 81-86, 1998 https://doi.org/10.3171/jns.1998.89.1.0081
  10. Friedman JA, Nichols DA, Meyer FB, Pichelmann MA, McIver JI, Toussaint LG 3rd, et al : Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol 24 : 526-533, 2003
  11. Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al : Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77 : 515-524, 1992 https://doi.org/10.3171/jns.1992.77.4.0515
  12. Halbach VV, Higashida RT, Dowd CF, Barnwell SL, Fraser KW, Smith TP, et al : The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg 80 : 659-666, 1994 https://doi.org/10.3171/jns.1994.80.4.0659
  13. Henkes H, Fischer S, Mariushi W, Weber W, Liebig T, Miloslavski E, et al : Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms. J Neurosurg 103 : 990-999, 2005 https://doi.org/10.3171/jns.2005.103.6.0990
  14. Krisht AF, Kadri PA : Surgical clipping of complex basilar apex aneurysms : a strategy for successful outcome using the pretemporal transzygomatic transcavernous approach. Neurosurgery 56 : 261-273; discussion 261-73, 2005 https://doi.org/10.1227/01.NEU.0000156785.63530.4E
  15. Krisht AF, Krayenbuhl N, Sercl D, Bikmaz K, Kadri PA : Results of microsurgical clipping of 50 high complexity basilar apex aneurysms. Neurosurgery 60 : 242-250; discussion 250-252, 2007
  16. Levy DI, Ku A : Balloon-assisted coil placement in wide-necked aneurysms. Technical note. J Neurosurg 86 : 724-727, 1997 https://doi.org/10.3171/jns.1997.86.4.0724
  17. Malek AM, Halbach VV, Phatouros CC, Lempert TE, Meyers PM, Dowd CF, et al : Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery 46 : 1397-1406; discussion 1406-1407, 2000 https://doi.org/10.1097/00006123-200006000-00022
  18. McDougall CG, Halbach VV, Dowd CF, Higashida RT, Larsen DW, Hieshima GB : Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils. J Neurosurg 84 : 393-399, 1996 https://doi.org/10.3171/jns.1996.84.3.0393
  19. Mericle RA, Wakhloo AK, Rodriguez R, Guterman LR, Hopkins LN : Temporary balloon protection as an adjunct to endosaccular coiling of wide-necked cerebral aneurysms: technical note. Neurosurgery 41 : 975-978, 1997 https://doi.org/10.1097/00006123-199710000-00045
  20. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al : International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised trial. Lancet 360 : 1267-1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  21. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al : International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005 https://doi.org/10.1016/S0140-6736(05)67214-5
  22. Moret J, Ross IB, Weill A, Piotin M : The retrograde approach : a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol 21 : 262-268, 2000
  23. Nakahara T, Kutsuna M, Yamanaka M, Sakoda K : Coil embolization of a large, wide-necked aneurysm using a double coil-delivered microcatheter technique in combination with a balloon-assisted technique. Neurol Res 21 : 324-326, 1999
  24. Nichols DA, Brown RD Jr, Thielen KR, Meyer FB, Atkinson JL, Piepgras DG : Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 87 : 374-380, 1997 https://doi.org/10.3171/jns.1997.87.3.0374
  25. Ogilvy CS, Hoh BL, Singer RJ, Putman CM: Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery 51 : 14-21; discussion 21-22, 2002 https://doi.org/10.1097/00006123-200207000-00003
  26. Pia HW : Classification of vertebro-basilar aneurysms. Acta Neurochir (Wien) 47 : 3-30, 1979 https://doi.org/10.1007/BF01404659
  27. Pierot L, Boulin A, Castaings L, Rey A, Moret J : Selective occlusion of basilar artery aneurysms using controlled detachable coils : report of 35 cases. Neurosurgery 38 : 948-953; discussion 953-954, 1996 https://doi.org/10.1097/00006123-199605000-00019
  28. Raymond J, Roy D : Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 41 : 1235-1245; discussion 1245-1246, 1997 https://doi.org/10.1097/00006123-199712000-00002
  29. Raymond J, Roy D, Bojanowski M, Moumdjian R, L'Esperance G : Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86 : 211-219, 1997 https://doi.org/10.3171/jns.1997.86.2.0211
  30. Roy D, Milot G, Raymond J : Endovascular treatment of unruptured aneurysms. Stroke 32 : 1998-2004, 2001 https://doi.org/10.1161/hs0901.095600
  31. Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L'Esperance G : Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 18 : 1207-1215, 1997
  32. Schievink WI, Wijdicks EF, Piepgras DG, Chu CP, O'Fallon WM, Whisnant JP : The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg 82 : 791-795, 1995 https://doi.org/10.3171/jns.1995.82.5.0791
  33. Tateshima S, Murayama Y, Gobin YP, Duckwiler GR, Guglielmi G, Vinuela F : Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils : anatomic and clinical outcomes in 73 patients from a single institution. Neurosurgery 47 : 1332-1339; discussion 1339-1342, 2000 https://doi.org/10.1097/00006123-200012000-00012
  34. Turk AS, Rappe AH, Villar F, Virmani R, Strother CM : Evaluation of the TriSpan neck bridge device for the treatment of wide-necked aneurysms: an experimental study in canines. Stroke 32 : 492-497, 2001 https://doi.org/10.1161/01.STR.32.2.492
  35. Vallee JN, Aymard A, Vicaut E, Reis M, Merland JJ : Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils : predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology 226 : 867-879, 2003 https://doi.org/10.1148/radiol.2263011957

피인용 문헌

  1. MR Imaging of Midbrain Pathologies vol.20, pp.2, 2009, https://doi.org/10.1007/s00062-010-0009-6
  2. Endovascular and Microsurgical Treatment of Superior Cerebellar Artery Aneurysms vol.14, pp.1, 2012, https://doi.org/10.7461/jcen.2012.14.1.29
  3. Treatment of Wide-Neck Basilar Tip Aneurysms Using the Web II Device vol.26, pp.6, 2013, https://doi.org/10.1177/197140091302600610
  4. Artery of Percheron infarct: An unusual cause for non-awakening from anesthesia vol.8, pp.5, 2009, https://doi.org/10.4103/1658-354x.144101
  5. Delayed Hydrocephalus and Perianeurysmal Cyst Formation After Stent-Assisted Coil Embolization of a Large, Unruptured Basilar Apex Aneurysm : A Case Report and Literature Review vol.3, pp.6, 2009, https://doi.org/10.1097/apo.0000000000000029
  6. Microsurgical treatment of basilar tip aneurysms: is it still acceptable? vol.75, pp.10, 2017, https://doi.org/10.1590/0004-282x20170120
  7. Large Basilar Apex Aneurysms Treated with Flow-Diverter Stents vol.38, pp.6, 2009, https://doi.org/10.3174/ajnr.a5167
  8. Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis vol.5, pp.None, 2019, https://doi.org/10.1186/s41016-019-0163-x
  9. Anterior temporal approach for clipping of ruptured basilar tip aneurysms: Surgical techniques and treatment outcomes vol.11, pp.None, 2020, https://doi.org/10.25259/sni_565_2019
  10. Recent advances in stent-assisted coiling of cerebral aneurysms vol.17, pp.6, 2009, https://doi.org/10.1080/17434440.2020.1778463