ENDOVASCULAR TREATMENT OF ACUTELY RUPTURED AND UNRUPTURED ANEURYSMS OF THE BASILAR BIFURCATION

The surgical treatment of basilar bifurcation aneurysms is difficult a nd the need for an alternative approach is frequently stated. To asses s the efficacy and safety of endovascular treatment of aneurysms locat ed at the basilar bifurcation, the authors prospectively studied angio graphic results, clinical results, and complications in 31 patients tr eated with Guglielmi detachable coils (GDCs). Patients treated acutely after subarachnoid hemorrhage (SAH) were graded according to the Hunt and Hess classification and clinical outcome was determined at 1- and 6-month intervals according to the Glasgow Outcome Scale (GOS).There were 18 women and 13 men, ranging in age from 34 to 67 years (mean age 48 years). Twenty-three were treated acutely after SAH. Clinical Hunt and Hess grades at presentation were as follows: Grade I, six patient s; Grade II, three; Grade III, 11; Grade IV, two; and Grade V, one. Th e GOS score for the group of patients treated acutely was: GOS I, 18 p atients; GOS II, III, and IV, one patient each; and GOS V, two patient s. There were seven technical complications in this group, most often asymptomatic, but one patient died after aneurysm rupture during treat ment and one had residual diplopia at 4 months. Eight patients were tr eated for incidental basilar bifurcation aneurysms. One technical comp lication with no neurological deficit occurred in this group of patien ts with incidental aneurysms. Immediate angiographic results were cons idered to be satisfactory in 94% of patients, with complete obliterati on in 42% and residual neck and dog ears in 52%. There was no bleeding episode after treatment during clinical follow-up periods ranging fro m 3 to 42 months (mean 15.5 months in 29 surviving patients). Angiogra phic results were available for 27 patients at 6 months and were as fo llows: 30% of the lesions were completely obliterated, 59% presented s ome residual neck, and 11% showed some opacification of the aneurysm s ac. During the follow-up period of up to 42 months, a total of seven r ecurrences were noted, necessitating retreatment with GDCs in five pat ients. Endovascular treatment of basilar bifurcation aneurysms prevent ed rebleeding and could be performed without clinically significant co mplications in 94% of patients. Clinical results after SAH compared fa vorably with surgical series. Morphological results appear less satisf actory, and long-term angiographic follow-up review is mandatory to de tect recurrences.