gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Microsurgery of fusiform vertebral artery aneurysms – own experience over the last 6 years

Meeting Abstract

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  • Siamak Asgari - Neurochirurgische Klinik, Klinikum Ingolstadt, Germany
  • Dierk Vorwerk - Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ingolstadt, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.09.08

doi: 10.3205/16dgnc151, urn:nbn:de:0183-16dgnc1514

Published: June 8, 2016

© 2016 Asgari et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: An increasing number of fusiform vertebral artery aneurysms (FVAA) were treated by endovascular interventions. Microsurgical clipping of these lesions disappeared from routine operative theatre even in neurovascular centers. Still, microsurgery may be an option in patients with FVAA in very experienced hands.

Method: During the last 6 years, seven patients with FVAA underwent microsurgical clipping procedures. Five patients suffered from SAH, and two patients had asymptomatic aneurysm. Cerebral DSA, CTA and MRI were performed preoperatively, DSA and CCT postoperatively in every patient. The FVAA morphologically were characterized into two different types according to the appearance in DSA. Type I defined an aneurysm with at least 50 percent fusiform and significant saccular component, Type II an aneurysm with exclusively fusiform component. The intraoperative photographs and videos were analyzed postoperatively.

Results: Indication for microsurgery was type I FVAA in 3 patients and type II in 4 patients. The far lateral approach was used in every patient. In all patients with type I FVAA and two patients with type II FVAA, direct aneurysm clipping and main vessel remodeling were achieved with preservation of the PICA. In one patient with type II aneurysm, proximal VA clip ligation with preservation of the PICA was performed. In the remaining patient with type II FVAA, trapping of the aneurysm with PICA preservation was achieved. In six patients, postoperative DSA showed complete aneurysm occlusion with PICA preservation. One patient with type I FVAA and preoperatively multiple SAHs sustained severe complication during tracheostomy tube change six weeks after surgery with fatal outcome. At the three-months-examination, six patients were alive. They presented an excellent, good, or fair neurological result (GOS 5 in three patients, GOS 4 in one patient, GOS 3 in two patients).

Conclusions: In type I aneurysms, direct aneurysm clipping is effective and safe. Occasionally, direct aneurysm clipping with main vessel remodeling is feasible in type II FVAA. Aneurysm trapping by clip insertion is the safest microsurgical treatment method in the type II lesions. In all patients, the risk and benefit of both microsurgery and endovascular treatment have to be compared by the neurovascular board. Naturally, the skills and experience of the microneurosurgeon are crucial in decision making.