[Vertebro-basilar aneurysms. 23 cases observed in a neurology department]

Twenty-three cases of vertebro-basilar aneurysms observed in a neurology department are reported. Ten were located on the basilar artery (7 at the basilar bifurcation), 5 on the postero-inferior cerebellar arteries, 4 on the superior cerebellar arteries, 3 on the vertebro-basilar junction and 1 on the anteroinferior cerebellar artery. There were 6 fusiform and giant aneurysms, others were sacciform. In 5 cases, there was no clear relationship between the clinical data and the aneurysm, which was discovered by chance at angiography or MRI. One giant aneurysm of the basilar artery was mimicking a tumor of the posterior cerebral fossa. Two other cases were revealed by brain stem ischaemia. Aneurysmal rupture was present in 15 cases: there were signs of meningeal haemorrhage in all cases and clinical signs of posterior cerebral fossa involvement in 7 cases. CT scan, performed in 8 cases, showed in all of them a meningeal haemorrhage, with a brain stem haematoma in 3 cases. All the aneurysms were shown by angiography; 7 were associated with a vasospasm. Five patients were not operated upon; all died. In one case, clipping the aneurysm was impossible, but there was a good recovery with a 12 year follow-up. Nine patients were operated, 3 recovered completely, 2 had neurological sequelae, 1 a late worsening; 3 patients died of brain stem ischaemia.