Neurosurgery Blog: Basilar Tip Aneurysms: A Microsurgical and Endovascular Contemporary Series of 100 Patients

Saturday, January 19, 2013

Basilar Tip Aneurysms: A Microsurgical and Endovascular Contemporary Series of 100 Patients

BACKGROUND: Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms. OBJECTIVE: We describe the variables our center evaluates when choosing to clip or coil basilar tip aneurysms and our outcomes. Four case illustrations are presented. METHODS: All patients with ruptured or unruptured basilar tip aneurysms from 2005 to April 2012 were examined. The patients were treated by 2 interventional neuroradiologists and 2 dually trained neurosurgeons. RESULTS: There were 63 ruptured (clipped 38%, coiled 62%) and 37 unruptured (clipped 35%, coiled 65%) aneurysms in this 100-patient study. Seventy percent of the patients with ruptured aneurysms and 92% of the patients with unruptured aneurysms had a good outcome (modified Rankin scale 0-2) at 3 months. For ruptured aneurysms, there was a statistically significant difference in clipping and coiling with respect to age and treatment modality (clip 48.8 years, coil 57.6 years). Patients in the coiled group had higher dome-to-neck (1.3 vs 1.1) (P = .01) and aspect ratios (1.6 vs 1.2) (P = .007). In the ruptured coiling group, 69.5% achieved a Raymond 1 radiographic outcome, 28% Raymond 2, and 2.5% Raymond 3. Eleven (17.4%) patients required re-treatment, and 3 (4.4%) patients were re-treated more than twice. Coiling of unruptured aneurysms resulted in 75% Raymond 1. There were no residual lesions for unruptured clipped aneurysms. There were no differences in outcome between clipping and coiling in the ruptured and unruptured group. CONCLUSION: In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment. ABBREVATIONS: BA, basilar artery COPD, chronic obstructive pulmonary disease H&H, Hunt and Hess grade IADSA, intra-arterial digital subtraction angiography ICA, internal carotid artery MEP, motor-evoked potential monitoring mRS, modified Rankin scale PCA, posterior cerebral artery PCOM, posterior communicating artery RAG, radial artery graft SAH, subarachnoid hemorrhage TIA, transient ischemic attack