Summary
The appropriate time to perform surgery for posterior circulation aneurysms is debated. Controversy exists secondary to the lack of information regarding the overall management and outcome, as well as difficulties with their surgical treatment and infrequent occurrence. The present study examines the results of 46 patients with ruptured vertebro-basilar aneurysms treated with a delayed surgical protocol. Twenty-four were Hunt-Hess grade I/II on admission, 13 were grade III, and 9 grade IV/V. Nineteen patients (40%) (4 grade I/II, 6 grade III, and the 9 grade IV/V on admission) died before meeting the required conditions for surgery. Causes of death were vasospasm (8 cases), direct effect of the initial bleeding (7 cases), and rebleeding (4 cases). Surgical results were excellent/good in 87% of the patients. Surgical mortality was 8% (2 out of 24). In this study, despite encouraging surgical results, overall mortality was disappointingly high. We suggest that as more experience is gained in treating vertebrobasilar aneurysms, early surgery should be performed in selected cases. Early surgery is prophylactic for rebleeding and allows for more aggressive treatment of cerebral vasospasm.
Similar content being viewed by others
References
Batjer HH, Samson DS (1989) Causes of morbidity and mortality from surgery of aneurysms of the distal basilar artery. Neurosurgery 25: 904–916
Drake CG (1979) The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26: 96–144
Fisher CM, Kistler JP, Davis JM (1977) Relation of cerebral vasospasm subarachnoid hemorrhage visualized by computed tomography scanning. Neurosurgery 1: 245–248
Flamm ES (1982) The timing of aneurysm surgery. In: Hopkins LN, Long DM (eds) Clinical management of intracranial aneurysms. Raven, New York, pp 135–141
Hernesniemi J, Vapalahti M, Niskanen M, Kari A (1992) Management outcome for vertebro-basilar artery aneurysms by early surgery. Neurosurgery 31: 857–862
Hunt WE, Hess RM (1968) Surgical risks as related to time of intervention in repair of intracranial aneurysms. J Neurosurg 28: 14–20
Kassell NF, Torner JC, Haley EC,et al (1990) The international cooperative study on the timing of aneurysm surgery. Part I. Overall management results. J Neurosurg 73: 18–36
Kassell NF, Torner JC, Jane JA,et al (1990) The international cooperative study on the timing of aneurysm surgery. Part II. Surgical results. J Neurosurg 73: 37–47
Laranjiera M, Sadasivan B, Malik GM,et al (1991) Early basilar artery aneurysm surgery in subarachnoid hemorrhage. Presented at the 59th Annual Meeting of the American Association of Neurological Surgeons, New Orleans, April 20–25, 1991
Le Roux PD, Elliott JP, Winn RH (1992) Basilar bifurcation aneurysms: results of early surgery. J Neurosurg 76: 382 (Abstract)
Peerless SJ (1992) Comment to 5. Neurosurgery 31: 861–862
Peerless SJ, Nemoto S, Drake CG (1987) Acute surgery for ruptured posterior circulation aneurysms. In: Symon L (ed) Advances and technical standards in neurosurgery, Vol 15. Springer, Wien New York, pp 115–129
Sugita K, Kobayashi S, Shintani A, Mutsuga N (1979) Microneurosurgery for aneurysms of the basilar artery. J Neurosurg 51: 615–620
Yaşargil MG (1986) Vertebro-basilar aneurysms. In: Microneurosurgery, Vol II. Thieme, New York, pp 232–295
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lanzino, G., Andreoli, A., Limoni, P. et al. Vertebro-basilar aneurysms: Does delayed surgery represent the best surgical strategy?. Acta neurochir 125, 5–8 (1993). https://doi.org/10.1007/BF01401820
Issue Date:
DOI: https://doi.org/10.1007/BF01401820