A comparison between endovascular and surgical management of basilar artery apex aneurysms

David P. Gruber, Gary A. Zimmerman, Thomas A. Tomsick, Harry R. Van Loveren, Michael J. Link, John M. Tew

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Object. The goal of this retrospective study was to evaluate endovascular treatment by means of Guglielmi detachable coils (GDCs) compared with surgical management for basilar artery (BA) apex aneurysms. Methods. Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treatment. Of 20 patients who underwent surgery and 21 who underwent GDC embolization, 15 (75%) and 11 (52%), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty-four (92%) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen patients with unruptured or ruptured aneurysms more than 14 days post-SAH were treated electively. Patients in the endovascular and surgical treatment groups had aneurysms with comparable dimensions and configurations. Overall, 15 (75%) of the surgical patients and 20 (95%) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAH, 11 (73%) of the surgical group and 10 (91%) of the endovascular group did well. Fourteen patients treated electively (93%) had good outcomes. There were two deaths (10%) in the surgical group and none in the endovascular group. Patients treated surgically were hospitalized twice as long and incurred twice the expenses of patients who underwent endovascular treatment (p < 0.001). Conclusions. Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long- term follow up is needed to better define the natural history of the endovascularly treated aneurysm and to further evaluate the accuracy of these preliminary results.

Original languageEnglish (US)
Pages (from-to)868-874
Number of pages7
JournalJournal of Neurosurgery
Volume90
Issue number5
StatePublished - May 1999
Externally publishedYes

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Intracranial Aneurysm
Subarachnoid Hemorrhage
Aneurysm
Glasgow Outcome Scale
Ruptured Aneurysm
Therapeutics
Natural History
Neck
Retrospective Studies

Keywords

  • Basilar artery
  • Endovascular therapy
  • Intracranial aneurysm
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Gruber, D. P., Zimmerman, G. A., Tomsick, T. A., Van Loveren, H. R., Link, M. J., & Tew, J. M. (1999). A comparison between endovascular and surgical management of basilar artery apex aneurysms. Journal of Neurosurgery, 90(5), 868-874.

A comparison between endovascular and surgical management of basilar artery apex aneurysms. / Gruber, David P.; Zimmerman, Gary A.; Tomsick, Thomas A.; Van Loveren, Harry R.; Link, Michael J.; Tew, John M.

In: Journal of Neurosurgery, Vol. 90, No. 5, 05.1999, p. 868-874.

Research output: Contribution to journalArticle

Gruber, DP, Zimmerman, GA, Tomsick, TA, Van Loveren, HR, Link, MJ & Tew, JM 1999, 'A comparison between endovascular and surgical management of basilar artery apex aneurysms', Journal of Neurosurgery, vol. 90, no. 5, pp. 868-874.
Gruber DP, Zimmerman GA, Tomsick TA, Van Loveren HR, Link MJ, Tew JM. A comparison between endovascular and surgical management of basilar artery apex aneurysms. Journal of Neurosurgery. 1999 May;90(5):868-874.
Gruber, David P. ; Zimmerman, Gary A. ; Tomsick, Thomas A. ; Van Loveren, Harry R. ; Link, Michael J. ; Tew, John M. / A comparison between endovascular and surgical management of basilar artery apex aneurysms. In: Journal of Neurosurgery. 1999 ; Vol. 90, No. 5. pp. 868-874.
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abstract = "Object. The goal of this retrospective study was to evaluate endovascular treatment by means of Guglielmi detachable coils (GDCs) compared with surgical management for basilar artery (BA) apex aneurysms. Methods. Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treatment. Of 20 patients who underwent surgery and 21 who underwent GDC embolization, 15 (75{\%}) and 11 (52{\%}), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty-four (92{\%}) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen patients with unruptured or ruptured aneurysms more than 14 days post-SAH were treated electively. Patients in the endovascular and surgical treatment groups had aneurysms with comparable dimensions and configurations. Overall, 15 (75{\%}) of the surgical patients and 20 (95{\%}) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAH, 11 (73{\%}) of the surgical group and 10 (91{\%}) of the endovascular group did well. Fourteen patients treated electively (93{\%}) had good outcomes. There were two deaths (10{\%}) in the surgical group and none in the endovascular group. Patients treated surgically were hospitalized twice as long and incurred twice the expenses of patients who underwent endovascular treatment (p < 0.001). Conclusions. Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long- term follow up is needed to better define the natural history of the endovascularly treated aneurysm and to further evaluate the accuracy of these preliminary results.",
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