Endovascular Treatment of Unruptured Vertebro-basilar Aneurysms

We reviewed 201 unruptured vertebro-basilar aneurysms encountered at our institute and 35 affiliated hospitals over the past 8 years. Of these, 106 aneurysms in 103 patients were treated with surgical or endovascular approaches: 43 aneurysms, surgically with clipping or wrapping; and 63 endovascularly with embolization. Outcome was excellent or good in 87 patients (84.5%). Among 24 patients with 36 complications, 16 had unfavorable outcomes including five deaths. Twelve patients (27.9%) with surgical treatment and two (3.3%) with endovascular treatment had unfavorable results because of treatment-related complications. Two patients with surgical treatment had complications related to perioperative management. Vascular occlusive complications were likeliest to occur in surgically treated basilar artery aneurysms (41%). Among surgically treated aneurysms the vertebral artery site was relatively associated with cranial nerve injuries. Complications numbered 36, occurring in 24 patients and 54% of complications affected outcome. Overall morbidity and mortality of surgical treatment were 18.6% and 7.0%, respectively, while those of endovascular treatment were 5.0% and 3.3%.

In conclusion, complications of surgery tend to be serious and affect outcome, and endovascular treatment is safer than surgical for vertebro-basilar aneurysms. Embolizations are particularly advantageous for patients who are poor surgical risks.