Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients

Area of Science:

• Neurosurgery
• Vascular Neurology
• Endovascular Therapy

Background:

• Vertebrobasilar dissecting aneurysms (VBD) are rare and often present with severe complications like subarachnoid hemorrhage (SAH).
• Their complex morphology frequently challenges conventional treatments, necessitating alternative approaches like parent artery exclusion or stenting.
• Microsurgical outcomes for VBD aneurysms remain less detailed compared to endovascular methods.

Purpose of the Study:

• To present patient outcomes from a large, single-surgeon series of microsurgically managed VBD aneurysms.
• To detail the effectiveness of microsurgical techniques in treating these rare vascular lesions.
• To provide illustrative case examples of microsurgical VBD aneurysm repair.

Main Methods:

• Retrospective review of medical records for patients with intracranial VBD aneurysms treated microsurgically over 19 years.
• Analysis of patient demographics, aneurysm characteristics, surgical procedures (clip wrapping, bypass trapping, parent artery sacrifice), and clinical outcomes (modified Rankin Scale [mRS]).

Main Results:

• 42 VBD aneurysms were treated microsurgically; 62% involved the posterior inferior cerebellar artery (PICA).
• 95% complete aneurysm obliteration rate with a 7% surgical complication rate.
• Good outcomes (mRS ≤ 2) were achieved in 48% of patients, with significantly better discharge home rates for unruptured vs. ruptured aneurysms (75% vs. 27%).

Conclusions:

• Microsurgical repair can yield favorable results in nearly half of VBD aneurysm cases, even those presenting with poor neurological status after rupture.
• Microsurgery remains a viable treatment option for VBD aneurysms.
• The choice between bypass trapping and clip wrapping is primarily determined by the aneurysm's location and its relationship to the PICA.