gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Article

Send article

Surgical management of aneurysms of the VA-PICA complex

Chirurgisches Management von Aneurysmen des Vertebralis-Pica-Komplexes

Meeting Abstract

Search Medline for

  • corresponding author L. Benes - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • C. Kappus - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • T. Dukatz - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • O. Bozinov - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • J. Rohlfs - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • U. Sure - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg
  • H. Bertalanffy - Universitätsklinikum Gießen und Marburg, Klinik für Neurochirurgie, Standort Marburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.05.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc026.shtml

Published: May 8, 2006

© 2006 Benes et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

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.