Artikel
Basilar tip aneurysms: Coiling versus clipping
Aneurysmen der Basilarisspitze: Coiling gegenüber Clipping
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Autoren
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U. Sure
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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O. Bozinov
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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L. Benes
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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S. Bien
- Klinik für Neuroradiologie, Philipps-Universität Marburg
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H. Bertalanffy
- Klinik für Neurochirurgie, Philipps-Universität Marburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: The treatment of basilar tip aneurysms is complex and still associated with considerable morbidity or even mortality. Endovascular interventions have been established as first choice treatment option for these aneurysms during the last decade. The purpose of this study was to analyze our experience with a combined interdisciplinary management protocol that was used in our institution for the past 8 years.
Methods: Between 05/1997 and 10/2005 69 patients with basilar tip aneurysms were treated at our institution. As a first treatment option, endovascular platinum coil embolization was attempted in all patients. When the interventional option (primary coiling) or therapy (complications or recoiling) failed, microsurgical clipping was performed as the second treatment option.
Results: Out of 69 patients, 53 (77%) were treated by coil embolization. One individual was treated by incomplete endovascular coiling of the aneurysm following microsurgical clipping. Altogether 16 patients (23%) were operated upon microsurgically because their aneurysms remained uneligible for endovascular treatment due to a variety of reasons. Of the 53 patients, who underwent endovascular therapy, twelve (23%) had transient neurological deterioration and four permanent deficits (8%). Seven patients out of 27 with endovascular treatment had recurrent aneurysms (27%). Three patients received additional coiling (11%) one of which had a severe infarction. One patient died due to a severe vasospasm in the early postinterventional period. Of the surgically treated patients, one individual experienced a partial but permanent oculomotor palsy (8%), whereas eight patients (47%) had short transient neurological deficits. There were no recurrent aneurysms in the surgical group.
Conclusions: Endovascular coil obliteration remains the first treatment choice for most of basilar tip aneurysms. In case of a broad neck, partially thrombosed or complex aneurysms, microsurgical clipping should be performed by an experienced vascular neurosurgeon. Such combined interdisciplinary treatment modality provides a good outcome for the majority of patients with basilar tip aneurysms. However, long-term follow-up is important due to the high percentage of recurrent aneurysms after endovascular treatment.
