Surgical Flow Diversion for Complex Posterior Circulation Aneurysms

Objective: We present our clinical experience of surgical flow diversion including extra-intracranial bypass surgery and vertebral artery occlusion as an alternative treatment in otherwise untreatable complex vertebrobasilar and posterior artery aneurysms.

Methods: We prospectively followed up four consecutive patients with fusiform and giant aneurysms of the posterior circulation, which underwent surgical treatment resulting in aneurysm flow diversion at our department.

Results: Four patients (1 female/3 male, mean age 47 years /range 21–59 years) were treated. Three patients had basilar artery aneurysms (one proximal fusiform aneurysm, two distal aneurysm fusiform and giant, respectively), one patient had a posterior artery giant aneurysm. All patients underwent superficial temporal artery-posterior cerebral artery bypass surgery. The mean modified Rankin Scale (mRS) score improved from 1.75 before surgery to 2.5 postoperatively. Posttreatment angiography revealed sufficient flow diversion in all cases. There was no perioperative mortality.

Conclusion: Surgical flow diversion was achieved by extra-intracranial bypass surgery in combination with surgical or endovascular vessel occlusion.