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Indian Journal of Neurosurgery 2012; 01(02): 119-123
DOI: 10.4103/2277-9167.102271
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Posterior circulation aneurysms: A 10-year institutional analysis

Saurabh Sharma
,
P. Sarat Chandra
,
Ansari Abuzer
,
Ashish Suri
,
Shailesh Gaikwad
1   Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
N.K. Mishra
1   Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
,
H.H. Dash
2   Neuroanesthesia, All India Institute of Medical Sciences, New Delhi, India
,
B.S. Sharma
,
A.K. Mahapatra
› Author Affiliations
Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

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Abstract

Background

Aneurysms are uncommon and challenging to manage.

Materials and Methods

A retrospective study was designed to report 53 patients who are treated from June 2002 to June 2011.

Results

The mean age at presentation was 46.34 ± 13.67 years (males, 26). Clinical features included subarachnoid hemorrhage (median Hunt and Hess Grade II, n = 42), cranial nerve palsies (9), hydrocephalus (5), and incidentally diagnosed (5). Locations included superior cerebellar artery (3), posterior cerebral artery (2), basilar trunk (4), vertebral (8), anterior inferior cerebellar artery (AICA) (5), posterior inferior cerebellar artery (PICA) (13), vertebrobasilar junction (6), and basilar top (13). Management included both endovascular intervention (26) and surgery (19), and both (2). Five patients presented as poor grade and underwent only extraventricular drain placement while one patient had thrombosed aneurysm and was managed conservatively. Mortality was 26.4% (n = 14) and morbidity included vasospasm (10), meningitis (2), pseudomeningocele (2), pneumonitis (2), and myocardial infarction (1).

Conclusion

Posterior circulation aneurysms are highly challenging. They require the multimodality approach, and decision regarding surgery or embolization has to be individualized.

Key words

Aneurysm - complications - management - posterior circulation
 

  • References

  • 1 Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 1995; 83: 843-853
    CrossrefPubMedGoogle Scholar
  • 2 Rinkel GJ, van Gijn J, Wijdicks EF. Subarachnoid hemorrhage without detectable aneurysm: A Review of the Causes. Stroke 1993; 24: 1403-1409
    CrossrefPubMedGoogle Scholar
  • 3 Eskridge JM, Song JK. Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial. J Neurosurg 1998; 89: 81-86
    CrossrefPubMedGoogle Scholar
  • 4 Drake CG, Peerless SJ, Hernesniemi JA. Surgery of Vertebrobasilar Aneurysms: London, Ontario Experience on 1767 Patients. Vienna: Springer-Verlag; 1996
    Google Scholar
  • 5 Mullan S. Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas. J Neurosurg 1974; 41: 657-670
    CrossrefPubMedGoogle Scholar
  • 6 Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J. et al International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised trial. Lancet 2002; 360: 1267-1274
    CrossrefPubMedGoogle Scholar
  • 7 Gnanalingham KK, Apostolopoulos V, Barazi S, O’Neill K. The impact of the international subarachnoid aneurysm trial (ISAT) on the management of aneurysmal subarachnoid haemorrhage in a neurosurgical unit in the UK. ClinNeurolNeurosurg 2006; 108: 117-123
    PubMedGoogle Scholar
  • 8 Andoh T, Shirakami S, Nakashima T, Nishimura Y, Sakai N, Yamada H. et al Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 1992; 31: 987-993
    CrossrefPubMedGoogle Scholar
  • 9 Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 1995; 36: 905-913
    CrossrefPubMedGoogle Scholar
  • 10 Flemming KD, Wiebers DO, Brown Jr RD, Link MJ, Nakatomi H, Huston III J. et al Prospective risk of hemorrhage in patients with vertebra basilar non saccular intracranial aneurysm. J Neurosurg 2004; 101: 82-87
    CrossrefPubMedGoogle Scholar
  • 11 Pozzati E, Andreoli A, Limoni P, Casmiro M. Dissecting aneurysms of the vertebrobasilar system: Study of 16 cases. Surg Neurol 1994; 41: 119-124
    CrossrefPubMedGoogle Scholar
  • 12 Matsubara S, Hadeishi H, Suzuki A, Yasui N, Nishimura H. Incidence and risk factors for the growth of unruptured cerebral aneurysms: Observation using serial computerized tomography angiography. J Neurosurg 2004; 101: 908-914
    CrossrefPubMedGoogle Scholar
  • 13 Mangrum WI, Huston III J, Link MJ, Wiebers DO, McClelland RL, Christianson TJH. et al Enlarging vertebrobasilar non saccular intracranial aneurysms: Frequency, predictors and clinical outcome of growth. J Neurosurg 2005; 102: 72-79
    CrossrefPubMedGoogle Scholar
  • 14 Eskridge JM, McAuliffe W, Song JK, Deliganis AV, Newell DW, Lewis DH. et al Balloon Angioplasty for the Treatment of Vasospasm. Neurosurgery 1998; 42: 510-517
    CrossrefPubMedGoogle Scholar
  • 15 Civit T, Auque J, Marchal JC, Bracard S, Picard L, Hepner H. Aneurysm clipping after endovascular treatment with coils: A report of eight patients. Neurosurgery 1996; 38: 955-961
    CrossrefPubMedGoogle Scholar
  • 16 Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 1995; 83: 843-853
    CrossrefPubMedGoogle Scholar
  • 17 Sundt TJ. Results of surgical management. In: Brown C. editor Surgical Techniques for Saccular and Giant Intracranial Aneurysms. Baltimore: Williams and Wilkins; 1990. p 19-23
    Google Scholar