Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction: Clinicopathological and Long-Term Follow-Up Study

Satoshi Kiyofuji; Hirofumi Nakatomi; Hideaki Ono; Minoru Tanaka; Kazuo Tsutsumi; Hiroyasu Kamiyama; Nobuhito Saito; Yoshiaki Shiokawa; Akio Morita; Kelly Flemming; Michael J. Link

doi:10.1055/s-0040-1702433

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702433

Oral Presentations

Georg Thieme Verlag KG Stuttgart · New York

Giant Fusiform and Dolichoectatic Aneurysms of the Basilar Trunk and Vertebrobasilar Junction: Clinicopathological and Long-Term Follow-Up Study

Authors

Satoshi Kiyofuji

¹Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
Hirofumi Nakatomi

¹Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
Hideaki Ono

¹Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
Minoru Tanaka

¹Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
Kazuo Tsutsumi

²Department of Neurosurgery, Showa General Hospital, Kodaira, Japan
Hiroyasu Kamiyama

³Department of Neurosurgery and Stroke, Teishinkai Hospital, Sapporo, Japan
Nobuhito Saito

¹Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
Yoshiaki Shiokawa

⁴Department of Neurosurgery, Kyorin University, Mitaka, Japan
Akio Morita

⁵Department of Neurosurgery, Nippon Medical University, Tokyo, Japan
Kelly Flemming

⁶Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States
Michael J. Link

⁷Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

Abstract

Volltext

Background: Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat.

Objective: We retrospectively analyzed our two-institution series to elucidate the factors affecting long-term survival.

Methods: Thirty-two patients with BTVBJ-GFDA treated at our hospitals were included in this study. Clinicopathological characteristics, treatment measures, and outcomes were based on the medical records and all available imaging studies. Autopsy and histological findings of the aneurysm and adjacent brain tissue were obtained in nine cases.

Results: Eleven patients did not undergo surgery, of whom 10 died (mortality 90.9%); three from progressive brainstem compression, four from subarachnoid hemorrhage, two from brainstem infarction, and one from associated atherosclerotic disease. Four types of surgical treatments were performed in 21 patients, consisting of immediate proximal parent artery occlusion, remote proximal parent artery occlusion, reconstructive clipping, and distal bypass, and these patients had significantly longer overall survival compared with those who received conservative therapy (adjusted hazard ratio: 1.508, 95% confidence interval: 1.058–2.148; p = 0.02). Histological examination of the aneurysms demonstrated staged clots, open lumen, and intrathrombotic channels with endothelial lining. A subgroup analysis demonstrated patients younger than 45 years of age had longer survival in Kaplan–Meier plots and the log rank test (p = 0.03). Those younger patient group had less atherosclerosis risk factors/diseases (p = 0.004), and tended to have favorable Pcom collaterals (p = 0.073). These differences could potentially guide treatments.

Conclusion: Parent artery occlusion should be performed at remote sites from the aneurysm, and ideal hemodynamic conditions within the aneurysm to maintain sufficient but not excess blood supply should be targeted based on the hemodynamics of both the posterior communicating arteries and perforating vessel collaterals.