Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms.

Area of Science:

• Neurosurgery
• Vascular Surgery
• Interventional Neurology

Background:

• Giant aneurysms of the vertebral and basilar arteries represent complex neurovascular lesions.
• Traditional microsurgical and endovascular techniques offer limited treatment options for these aneurysms.

Purpose of the Study:

• To evaluate the long-term outcomes of patients treated for vertebrobasilar aneurysms using extracranial-intracranial bypass and flow reduction techniques.

Main Methods:

• Retrospective review of a prospective database of aneurysm cases treated between December 1993 and August 2011.
• Patients underwent extracranial-intracranial bypass combined with either complete or partial occlusion of the basilar artery or distal vertebral arteries.

Main Results:

• Twelve aneurysms in 11 patients (3 basilar apex, 2 basilar trunk, 7 vertebrobasilar junction) were treated.
• The bypass patency rate was 92.3%, with a perioperative mortality rate of 18.2%.
• Long-term outcomes were poor, with 6 of 11 initial patients dying, and 4 aneurysms requiring re-treatment due to growth.

Conclusions:

• Vertebrobasilar aneurysms are difficult to treat, with limited effective microsurgical or endovascular options.
• Aggressive surgical management with bypass and flow reduction yields a high bypass patency but a poor long-term prognosis for most patients.