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A comparison between endovascular and surgical management of basilar artery apex aneurysms
D P Gruber1, G A Zimmerman, T A Tomsick
1The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine, and the Mayfield Clinic and Spine Institute, Ohio 45267-0515, USA.
Insights
Endovascular embolization using Guglielmi detachable coils (GDCs) is a viable alternative to surgery for basilar artery apex aneurysms, showing comparable outcomes with reduced hospital stays and costs.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Basilar artery (BA) apex aneurysms present unique treatment challenges.
- Surgical clipping and endovascular coiling are primary treatment modalities.
- Comparative effectiveness data for these treatments are crucial for clinical decision-making.
Purpose of the Study:
- To compare the efficacy and outcomes of endovascular treatment with Guglielmi detachable coils (GDCs) versus surgical management for basilar artery apex aneurysms.
- To evaluate treatment outcomes based on aneurysm presentation (acute vs. elective) and patient condition.
Main Methods:
- Retrospective analysis of 41 patients with saccular BA apex aneurysms.
- Patients were treated with either surgery (n=20) or GDC embolization (n=21).
- Outcomes assessed using the Glasgow Outcome Scale (GOS), considering acute and elective treatment phases.
Main Results:
- Good outcomes (GOS 4 or 5) were achieved in 75% of surgical patients and 95% of endovascularly treated patients.
- In acute subarachnoid hemorrhage (SAH) cases, 73% of surgical patients and 91% of endovascular patients had good outcomes.
- Endovascular treatment resulted in shorter hospitalizations and lower costs compared to surgery (p<0.001).
Conclusions:
- Endovascular GDC embolization is a competitive alternative to surgical clipping for select basilar artery apex aneurysms.
- Further long-term follow-up is necessary to confirm the durability of endovascular treatment and refine results.
- The findings suggest endovascular coiling may offer advantages in terms of patient recovery and resource utilization.
Object:
The goal of this retrospective study was to evaluate endovascular treatment by means of Guglielmi detachable coils (GDCs) compared with surgical management for basilar artery (BA) apex aneurysms.
Methods:
Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treatment. Of 20 patients who underwent surgery and 21 who underwent GDC embolization, 15 (75%) and 11 (52%), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty-four (92%) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen patients with unruptured or ruptured aneurysms more than 14 days post-SAH were treated electively. Patients in the endovascular and surgical treatment groups had aneurysms with comparable dimensions and configurations. Overall, 15 (75%) of the surgical patients and 20 (95%) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAH, 11 (73%) of the surgical group and 10 (91%) of the endovascular group did well. Fourteen patients treated electively (93%) had good outcomes. There were two deaths (10%) in the surgical group and none in the endovascular group. Patients treated surgically were hospitalized twice as long and incurred twice the expenses of patients who underwent endovascular treatment (p<0.001).
Conclusions:
Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long-term follow up is needed to better define the natural history of the endovascularly treated aneurysm and to further evaluate the accuracy of these preliminary results.