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Fusiform aneurysms of the vertebrobasilar complex: a single-center series

  • Original Article - Vascular Neurosurgery - Aneurysm
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Abstract

Background

Fusiform vertebrobasilar aneurysms (FVBAs) may exhibit a disastrous clinical course. Due to their rare occurrence, evidence concerning optimal management is lackluster.

Objective

To describe the epidemiology, clinical features and treatment outcomes of a consecutive series of patients admitted to our institution.

Methods

We retrospectively evaluated patient charts with respect to clinical presentation, treatment procedures, and the outcomes of all patients diagnosed with an FVBA, which were seen at our institution between March 2006 and February 2017.

Results

Forty-five consecutive patients were analyzed. Follow-up was available for 39 patients (86.7%) with a median duration of 28.8 months. Seventeen patients (37.7%) were asymptomatic, 14 patients (31.1%) presented with brainstem ischemia, 8 patients (17.8%) with supratentorial ischemia, and 3 (6.7%) patients with brain stem compression. Aneurysm rupture occurred in 3 patients upon presentation (6.7%). Initially, 19 patients (42.2%) were significantly disabled with Modified Rankin Scale (mRS) scores ≥ 3. Twelve patients (26.7%) underwent invasive treatment: endovascular therapy in 9 cases and surgical treatment in 3 cases. Thirty-three patients received conservative treatment. During follow-up, 6 events (66.7%) of severe disability or death (mRS 4–6) occurred in the endovascular group versus 1 event (33%) in the surgical group versus 19 events (63.3%) among conservatively treated aneurysms. Deterioration was significantly more frequent in patients with symptomatic aneurysms (p = 0.030).

Conclusion

Patients harboring an FVBA frequently present with disabling symptoms caused by various pathomechanisms. The natural history is aggressive, mostly for initially symptomatic aneurysms, and periprocedural morbidity of surgical or endovascular treatment remains substantial.

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Author notes

  1. Jens Lehmberg and Maria Wostrack contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, Munich, Germany

    Arthur Wagner, Bernhard Meyer, Jens Lehmberg & Maria Wostrack

  2. Department of Diagnostic and Interventional Neuroradiology, Helios Klinikum München West, Munich, Germany

    Sascha Prothmann

  3. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich School of Medicine, Munich, Germany

    Dennis Hedderich

  4. Department of Neurology, Klinikum rechts der Isar, Technical University Munich School of Medicine, Munich, Germany

    Silke Wunderlich

  5. Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany

    Jens Lehmberg

Authors
  1. Arthur Wagner
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Corresponding author

Correspondence to Arthur Wagner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was executed in accordance with the Declaration of Helsinki; a positive vote by the local ethics committee was obtained beforehand (Ethikkommission der Technischen Universität München; registration number 5020/11).

Informed consent

The requirement for written informed consent was waived by the ethics committee due to the study’s retrospective design.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Wagner, A., Prothmann, S., Hedderich, D. et al. Fusiform aneurysms of the vertebrobasilar complex: a single-center series. Acta Neurochir 162, 1343–1351 (2020). https://doi.org/10.1007/s00701-020-04304-x

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  • DOI: https://doi.org/10.1007/s00701-020-04304-x

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