Treatment of Ruptured Aneurysms in the Posterior Circulation

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All cases of ruptured aneurysms in the posterior circulation treated in our department over a 19-year period were reviewed to assess relationships between the timing of surgery, preoperative grade, angiographic findings, operative approach and clinical outcome. There were 33 patients, of whom 16 had basilar bifurcation aneurysms, 15 had VA or VA-PICA aneurysms and two had PCA-Pcom aneurysms. The major findings were as follows:<BR>(1) Basilar bifurcation aneurysms. Eleven patients underwent direct operation, three died before surgery and two were treated non-surgically. Overall mortality plus vegetative rate was 44%, and only 38% returned to normal activities. The major causes of poor outcome among the surgical cases were preoperative severe illness (grade 3-4), anatomical difficulties in accessing the aneurysm (high position, posterior projection and large dome) and vasospasm. As for the timing of surgery, the outcome for patients assigned to undergo delayed operation was no better than for those operated on within two weeks after SAH. To improve the operative results, we would choose early operation to prevent rebleeding and facilitate the prophylactic management of the vasospasm. <BR>(2) VA, VA-PICA aneurysm. All of 15 patients underwent direct surgery. Eleven patients returned to normal activities, three could care for themselves and one died. There were six operative morbidity, four IX, X paresis, one VI palsy and one cerebellar ataxia, all of which disappeared completely except for the two IX, X paresis. The larger the dome of the aneurysm, the more operative morbidity we met. Better outcome was obtained by early surgery than when surgery was delayed.
The Japanese Society on Surgery for Cerebral Strokeの論文

Treatment of Ruptured Aneurysms in the Posterior Circulation

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