gms | German Medical Science

During the last 10 years, 1233 aneurysms have been treated in our hospital. Out of 1056 aneurysms of the anterior circulation, 590 (55%) were treated by endovascular techniques and 466 (45%) by surgery. Out of 177 aneurysms of the posterior circulation, 155 (88%) were treated by endovascular techniques and 22 (12%) by surgery. This series of 22 patients constitutes the base of the present communication.

The locations of the aneurysms were the following: 6 PICA origin, 4 PCA (P1), 4 VA, 3 Basilar tip, 2 SCA, 2 V-B junction, 1 Basilar trunk. Six cases were giant aneurysms, 5 dissecting aneurysms and 3 recanalized aneurysms (following endovascular treatment).

Different surgical approaches were used: 1) standard suboccipital lateral/ far lateral 2) far lateral associated with transpetrous 3) combined-combined (lateral plus transpetrous and supratentorial-infratentorial route 4) fronto-orbito-zygomatic.

In 3 patients the cardiocirculatory arrest was used and in 2 cases an EC-IC bypass was performed. The operative mortality was 9% (2 pts) and t severe operative morbidity was observed in 4,5% (1 pt).

The main lesson we can learn from this experience is that surgery has a limited role in repairing posterior circulation aneurysms. Surgery can be used as a first therapeutic option solely for aneurysms of PICA origin following the same rules adopted for operating anterior circulation aneurysms (i.e. young patients and good general conditions).

For the rest of the posterior circulation aneurysms, surgery has to be considered in the following cases: presence of significant brain stem compression (clinical and radiological signs), recanalized aneurysms after coiling, selected cases of dissecting aneurysm, particularly when the sacrifice of the affected vessel is too risky or when the dissection is uncertain on the basis of radiological investigations.