Nakatomi H, Kiyofuji S, Ono H, Tanaka M, Kamiyama H, Takizawa K, Imai H, Saito N, Shiokawa Y, Morita A, Flemming KD, Link MJ. Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction-Clinicopathological and Surgical Outcome.
Neurosurgery 2021;
88:82-95. [PMID:
32745190 PMCID:
PMC7891276 DOI:
10.1093/neuros/nyaa317]
[Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND
Giant fusiform and dolichoectatic aneurysms of the basilar trunk and
vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat.
OBJECTIVE
To evaluate factors influencing survival and outcome of BTVBJ-GFDA by
performing a retrospective multicenter cohort study.
METHODS
A total of 32 patients with BTVBJ-GFDA were included in this study.
Clinicopathological characteristics, treatment measures, and outcomes were
collected from medical records and imaging studies. Autopsy and histological
findings of the aneurysm and adjacent brain tissue were also obtained in 9
cases.
RESULTS
A total of 11 patients did not undergo surgery, of whom 10 died; 3 from
progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from
brainstem infarction, and 1 from associated atherosclerotic disease. The
remaining 21 patients underwent a surgical treatment, consisting of
immediately proximal parent artery occlusion, remotely proximal parent
artery occlusion, clip reconstruction, and distal bypass and achieved
significantly longer overall survival compared with those who received
conservative therapy (adjusted hazard ratio 1.508, 95% CI
1.058-2.148, P = .02). Histological
examination of the aneurysms demonstrated staged clots, open lumen, and
intrathrombotic channels with endothelial lining. The patients younger than
45 yr of age showed statistically longer survival than those equal and older
than 45 yr (P = .03).
CONCLUSION
Surgical intervention achieved greater survival than conservative management
in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the
aneurysm to maintain sufficient but not excess supply should be targeted
based on the hemodynamics of both the posterior communicating arteries and
perforating vessel collaterals.
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