Review of current treatment modalities and clinical outcome of giant saccular aneurysms of the basilar apex

IF 1.9 Q3 CLINICAL NEUROLOGY Brain & spine Pub Date : 2024-01-01 DOI:10.1016/j.bas.2024.103333
Andreas Theofanopoulos , Lucas Troude , Milad Neyazi , Sajjad Muhammad
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Abstract

Introduction

Giant aneurysms of the basilar apex represent formidable challenges as the high rupture rate of untreated lesions must be balanced against the technical complexity and potential morbidity of intervention.

Research question

Review of treatment modalities and outcomes of patients harboring giant (>2.5 cm) basilar apex saccular aneurysms, in an effort to refine treatment decision-making.

Material and methods

A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant basilar apex saccular aneurysms treated either microsurgically or endovascularly. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, angiographic and clinical outcomes as well as follow-up information were obtained.

Results

Data from 32 studies fulfilling the inclusion criteria, including 49 patients (32 treated surgically and 17 endovascularly) was obtained. Mean patient age at presentation was 51.69 years, with a male-to-female ratio of 1:2. Mean maximum aneurysm diameter was 30.57 mm. A favorable outcome (mRS 0–2) was reported on 70.6% of endovascular and 56.3% of open surgical cases. Complete aneurysm occlusion was achieved in 55.6% of the open and 23.5% of the endovascular cases. Death rate was 33% for endovascular and 15.6% for open cases; the higher mortality of endovascular treatment is mainly attributed to the mass effect from continued brainstem compression after treatment.

Discussion and conclusion

Higher rates of complete occlusion but higher morbidity are associated with microsurgery compared to endovascular modalities. Severe, clinically apparent brainstem mass effect may require decompression associated with microsurgery, when technically feasible.

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基底动脉尖巨大囊状动脉瘤的现有治疗方法和临床疗效综述
导言基底动脉顶巨大动脉瘤是一项艰巨的挑战,因为未经治疗的病变破裂率很高,必须在介入治疗的技术复杂性和潜在发病率之间取得平衡。材料和方法根据PRISMA指南,通过PubMed和Scopus数据库进行了系统的文献综述,以确定以显微手术或血管内治疗的巨大基底动脉瘤病例。结果 32 项研究的数据符合纳入标准,包括 49 例患者(32 例手术治疗,17 例血管内治疗)。患者发病时的平均年龄为 51.69 岁,男女比例为 1:2。动脉瘤最大直径平均为 30.57 毫米。70.6%的血管内手术病例和56.3%的开放手术病例获得了良好的治疗效果(mRS 0-2)。55.6%的开放手术和23.5%的血管内手术病例实现了动脉瘤完全闭塞。血管内手术病例的死亡率为 33%,开放手术病例的死亡率为 15.6%;血管内治疗死亡率较高的主要原因是治疗后持续压迫脑干造成的肿块效应。在技术可行的情况下,严重的、临床上明显的脑干肿块效应可能需要结合显微手术进行减压。
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
发文量
0
审稿时长
71 days
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