Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction—clinicopathological and surgical outcome

Hirofumi Nakatomi, Satoshi Kiyofuji, Hideaki Ono, Minoru Tanaka, Hiroyasu Kamiyama, Katsumi Takizawa, Hideaki Imai, Nobuhito Saito, Yoshiaki Shiokawa, Akio Morita, Kelly D. Flemming, Michael J. Link

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat. OBJECTIVE: To evaluate factors influencing survival and outcome of BTVBJ-GFDA by performing a retrospective multicenter cohort study. METHODS: A total of 32 patients with BTVBJ-GFDA were included in this study. Clinicopathological characteristics, treatment measures, and outcomes were collected from medical records and imaging studies. Autopsy and histological findings of the aneurysm and adjacent brain tissue were also obtained in 9 cases. RESULTS: A total of 11 patients did not undergo surgery, of whom 10 died; 3 from progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from brainstem infarction, and 1 from associated atherosclerotic disease. The remaining 21 patients underwent a surgical treatment, consisting of immediately proximal parent artery occlusion, remotely proximal parent artery occlusion, clip reconstruction, and distal bypass and achieved significantly longer overall survival compared with those who received conservative therapy (adjusted hazard ratio 1.508, 95% CI 1.058-2.148, P = .02). Histological examination of the aneurysms demonstrated staged clots, open lumen, and intrathrombotic channels with endothelial lining. The patients younger than 45 yr of age showed statistically longer survival than those equal and older than 45 yr (P = .03). CONCLUSION: Surgical intervention achieved greater survival than conservative management in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the aneurysm to maintain sufficient but not excess supply should be targeted based on the hemodynamics of both the posterior communicating arteries and perforating vessel collaterals.

Original languageEnglish (US)
Pages (from-to)82-95
Number of pages14
JournalNeurosurgery
Volume88
Issue number1
DOIs
StatePublished - Jan 1 2021

Keywords

  • Basilar trunk
  • Dolichoectasia
  • Dolichoectatic aneurysms
  • Fusiform aneurysms
  • Megadolichobasilar anomaly
  • Vertebrobasilar junction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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