Surgical and Endovascular Management of Ruptured Posterior Circulation Aneurysms

2017 ◽  
pp. 804-811
Author(s):  
R. Tahir ◽  
M. Kole
Keyword(s):  
Posterior Circulation ◽  
Endovascular Management ◽  
Posterior Circulation Aneurysms

Incidental Medium-Sized Basilar Tip Aneurysm

2019 ◽  
pp. 109-118
Author(s):  
Ethan A. Winkler ◽  
W. Caleb Rutledge ◽  
Alex Lu ◽  
Adib A. Abla
Keyword(s):  
Open Surgery ◽  
Posterior Circulation ◽  
Endovascular Management ◽  
Unruptured Aneurysms ◽  
Microsurgical Clipping ◽  
Wide Range ◽  
Posterior Circulation Aneurysms ◽  
History Of ◽  
Management Techniques ◽  
Basilar Tip Aneurysm

Abstract: Posterior circulation aneurysms, including those in the basilar tip location, are commonly seen in neurosurgical practice. They represent about 10% of aneurysms. Although posterior circulation aneurysms are often treated via endovascular means, microsurgical clipping of basilar tip aneurysms is still occasionally indicated. A thorough understanding of the natural history of unruptured aneurysms in all locations is needed to drive proper management, and the higher rupture risk of posterior circulation aneurysms must be considered. Endovascular management techniques for these aneurysms now employ a wide range of strategies to achieve complete occlusion. For those treated with open surgery, careful patient selection and excellent microsurgical technique are essential for effective treatment.

scholarly journals Modern aneurysm surgery: a pro-open surgery view

2018 ◽  
pp. 162-167
Author(s):  
A.V. Dubovoy ◽  
A.V. Bervitskiy ◽  
A. Spallone
Keyword(s):  
Endovascular Management ◽  
Anterior Circulation ◽  
Management Philosophy ◽  
Great Debate ◽  
Number Of Patients ◽  
Proper Training ◽  
Posterior Circulation Aneurysms ◽  
Technical Refinement ◽  
Modern Era ◽  
Endovascular Devices

Modern management of intracranial aneurysms is matter of great debate between supporters of “traditional” microsurgical treatment and those of relatively new endovascular management. This paper briefly reports the experience of two experienced microvascular “traditional” neurosurgeons who shares the same management philosophy favouring open microsurgery in the modern era in which endovascular management is becoming fashionable. Difficult posterior circulation aneurysms are nowadays as a rule managed endovascularly, whilst anterior circulation aneurysms can be treated with both techniques, and MCA as well as distal ACA aneurysms are better treated microsurgically. Technical refinement and — hopefully- lower cost of endovascular devices will favour a trend of prevailing use of endovascular method in the future. However the need for well-prepared microvascular surgeon will always be there, and proper training of future generations of microvascular surgeons in a setting of decreasing number of patients and open surgical casuistics represents a big challenge for the neurosurgical community, to which an answer should be given.

Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Nina Brawanski ◽  
Sepide Kashefiolasl ◽  
Sae-Yeon Won ◽  
Joachim Berkefeld ◽  
Elke Hattingen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Admission Status ◽  
Posterior Circulation Aneurysms

Abstract Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

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