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21.06.2017 | Original Article - Vascular

Surgical treatment of unruptured distal basilar artery aneurysm: durability and risk factors for neurological worsening

verfasst von: Hidetoshi Matsukawa, Hiroyasu Kamiyama, Takanori Miyazaki, Yu Kinoshita, Toshiyuki Tsuboi, Kosumo Noda, Nakao Ota, Norihiro Saito, Rihee Takeda, Sadahisa Tokuda, Rokuya Tanikawa

Erschienen in: Acta Neurochirurgica | Ausgabe 9/2017

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Abstract

Background

Distal basilar artery aneurysms (DBAs) consist of basilar apex and basilar artery-superior cerebellar artery bifurcation (BA-SCA) aneurysms. The authors aimed to investigate clinical and radiological differences between two locations and to evaluate the 12-month surgical outcome in unruptured DBAs.

Methods

Fifty-six consecutive patients who underwent surgical treatment (37 basilar apex and 19 BA-SCA aneurysms) between April 2012 and February 2016 were retrospectively evaluated. In patients with a preoperative modified Rankin Scale score (mRS) of more than 1, neurological worsening (NW) was defined as an increase in one or more mRS. In patients without symptoms, NW was defined as mRS ≥2.

Results

The mean age of the patient population was 64 ± 9.6 years, and 48 (86%) were female. Mean follow-up period was 2.6 ± 0.94 years. An excellent (mRS 0 to 1) outcome was archived in 31 (55%), 45 (82%), and 48 (87%) patients at 30 days, 6 months, and 12 months, respectively. Clinical and radiological characteristics showed no differences between two locations. One early death (1.8%) and one severe morbidity (1.8%) due to rupture were observed. The postoperative annual rupture rate was 1.4% overall (145 patient-years). After adjustment for age and location, large or giant DBA was related to 30-day and 12-month NW [n = 22 (39%) and n = 6 (11%); p = 0.009 and 0.002, respectively], aneurysm localization in the interpeduncular cistern (LIC) and perforator territory infarction were related to 30-day NW (p = 0.002 and 0.002), and DBA that needed bypass surgery and previously treated recurrent DBA were related to NW at 12 months (p = 0.017 and 0.001). Multivariate analysis showed that LIC was significantly related to perforator territory infarction (p = 0.003).

Conclusions

Clinical and radiological characteristics were not different between basilar apex and BA-SCA aneurysms; therefore, they should not be discussed separately. To avoid neurological worsening, results of surgical treatment for unruptured DBAs should be improved.

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Titel: Surgical treatment of unruptured distal basilar artery aneurysm: durability and risk factors for neurological worsening
verfasst von: Hidetoshi Matsukawa
Hiroyasu Kamiyama
Takanori Miyazaki
Yu Kinoshita
Toshiyuki Tsuboi
Kosumo Noda
Nakao Ota
Norihiro Saito
Rihee Takeda
Sadahisa Tokuda
Rokuya Tanikawa
Publikationsdatum: 21.06.2017
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 9/2017
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3239-4

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Surgical treatment of unruptured distal basilar artery aneurysm: durability and risk factors for neurological worsening