Bypass and Flow Reduction for Unclippable and Uncoilable Vertebrobasilar Aneurysms

Object: Complex aneurysms of the vertebral and basilar arteries are formidable lesions for both microsurgical and endovascular treatments. We evaluated the long-term outcomes of patients with complex basilar and vertebrobasilar junction aneurysms not amenable to endovascular therapy or microsurgical clipping, who were treated with extracranial-intracranial (EC-IC) bypass and vessel sacrifice.

Methods: We retrospectively reviewed a database of patients with these complex aneurysms treated with EC-IC bypass and vessel sacrifice for flow reversal/reduction.

Results: Eleven patients with 12 giant or complex basilar and vertebrobasilar junction aneurysms were identified. The majority of patients presented with symptoms suggestive of mass effect (n = 5) or embolic episodes (n = 4). There were five saccular and seven fusiform aneurysms. There were three basilar apex aneurysms, two aneurysms of the basilar trunk, and seven vertebrobasilar junction aneurysms. Postoperative bypass patency rate was 92.3% (12/13). The perioperative mortality rate for the initial treatment was 18.2% (2/11). The mean follow-up was 71.6 months (range, 4-228 months; median, 49 months). Of the initial group of 11 patients, 6 were treated successfully and 5 died. At last follow-up for all patients, the mean mRS score was 3.45 (range, 1-6; median, 3).

Conclusions: Complex aneurysms of the basilar and vertebral arteries are challenging lesions with limited microsurgical or endovascular options.