Cerebral revascularization for complex vertebrobasilar artery dissecting aneurysms

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Neuroradiology

Background:

• Vertebrobasilar artery dissecting aneurysms (VBDAs) represent a significant neurosurgical challenge due to their complex anatomy and high risk.
• Cerebral revascularization has emerged as a crucial treatment modality for intricate VBDA cases.

Purpose of the Study:

• To retrospectively analyze the characteristics, surgical outcomes, and follow-up data of patients treated for complex VBDAs using cerebral revascularization.
• To evaluate the safety and efficacy of cerebral revascularization as a treatment strategy for VBDAs.

Main Methods:

• Retrospective analysis of 21 patients who underwent cerebral revascularization for complex VBDAs between 2015 and 2022.
• Classification of VBDAs into four groups based on location and relationship with the posterior inferior cerebellar artery (PICA).
• Application of a tailored surgical algorithm considering aneurysm location, status, and vertebrobasilar artery blood flow.

Main Results:

• 20 out of 21 patients showed clinical improvement or no change; 17 achieved favorable functional outcomes (modified Rankin Scale ≤ 2).
• Aneurysm obliteration was achieved in 13 patients, with shrinkage in 5 and stabilization in 2.
• All bypasses remained patent during a median follow-up of 32.5 months, with 11 patients showing further clinical improvement.

Conclusions:

• Cerebral revascularization is a safe and effective treatment for complex VBDAs.
• This technique can serve as a valuable complementary strategy in managing VBDA patients.
• Tailored surgical approaches based on aneurysm characteristics yield favorable outcomes.