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Vertebro-basilar aneurysms: does delayed surgery represent the best surgical strategy?
G Lanzino1, A Andreoli, P Limoni
1First Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
Acta Neurochirurgica
|January 1, 1993
Summary
Delayed surgery for ruptured posterior circulation aneurysms had high mortality, despite good surgical outcomes. Early intervention in select cases may improve survival by preventing rebleeding and treating vasospasm.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Management and outcomes of posterior circulation aneurysms remain debated due to treatment complexities and rarity.
- Delayed surgical protocols are often employed, but their efficacy requires further investigation.
Purpose of the Study:
- To evaluate the outcomes of a delayed surgical protocol for ruptured vertebro-basilar aneurysms.
- To assess the impact of delayed surgery on patient mortality and morbidity.
Main Methods:
- Retrospective analysis of 46 patients with ruptured vertebro-basilar aneurysms treated with delayed surgery.
- Patients were categorized by Hunt-Hess grade on admission.
- Outcomes including mortality, morbidity, and causes of death were recorded.
Main Results:
- Overall mortality was high (40%), with deaths occurring before surgery due to vasospasm, initial bleeding effects, or rebleeding.
- Among patients who underwent surgery, excellent/good results were achieved in 87%, with a surgical mortality of 8%.
- Delayed surgery resulted in disappointingly high overall mortality despite favorable surgical outcomes.
Conclusions:
- While surgical results for vertebro-basilar aneurysms can be good, a delayed approach leads to high overall mortality.
- Early surgical intervention in selected cases is suggested to reduce rebleeding and facilitate aggressive vasospasm management.
- Further experience may refine indications for early surgery in posterior circulation aneurysms.