Article
Surgical management of aneurysms of the VA-PICA complex
Chirurgisches Management von Aneurysmen des Vertebralis-Pica-Komplexes
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Published: | May 8, 2006 |
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Objective: Most of the vertebral artery and PICA aneurysms can be treated endovascularly. Despite continuous improvements in endovascular techniques, a subset of patients with VA-PICA aneurysms require surgery. This is still a challenging task due to the close topographical relationship to eloquent structures. A consecutive series of patients was retrospectively reviewed to analyze indications and strategies for the surgical management of aneurysms of the VA-PICA complex.
Methods: A total of 31 patients were treated microsurgically for aneurysms of the VA-PICA complex in 3 different locations: VA-PICA (n=9), PICA (n=13), vertebral artery (n=9). Four of these were additionally treated for arteriovenous malformations. The aneurysms were exposed via the transcondylar (n=19), lateral suboccipital (n=3) or paramedian suboccipital (n= 9) route.
Results: Thirty-four aneurysms were treated with different therapeutic procedures, of which 24 were clipping, 1 coating, 1 coagulation, 2 PICA end-to-end anastomosis, 2 VA-PICA anastomosis and 1 aneurysm excision. Overall, 26 patients (83.9%) had good outcomes (Glasgow Outcome Scale 4 or 5, mean follow-up, 3.7 yrs). The treatment mortality rate was 9.7% (n=3), and permanent treatment-associated neurological morbidity rate was 6.4% (n=2). In five patients (16.1%) with hydrocephalus a VP-Shunt was necessary.
Conclusions: In a multimodality treatment concept for aneurysms of the VA-PICA complex, surgery remains a unique contribution to the overall management of aneurysms of the posterior fossa. Our results show that these complex vascular lesions can be treated surgically with reasonable long-term results in the majority of our patients, if the management strategies of these lesions are individually tailored.