Interdisciplinary management results in 100 patients with ruptured and unruptured posterior circulation aneurysms

The authors report on a series of 100 posterior circulation aneurysms manag ed by surgical and endovascular procedures. The series consisted of 41 elec tive admissions more than 14 days after SAH or for unruptured aneurysms and 59 acute admissions after subarachnoid haemorhage (SAH). In this first interdisciplinary series after the introduction of electrolyt ically detachable coils, surgical clipping was maintained as treatment of c hoice in good grade patients while endovascular therapy was primarily offer ed for patients in poor clinical grade or if the aneurysm was judged diffic ult to be accessed surgically. A total of 70 patients underwent aneurysm el imination, 54 surgically and 16 by the endovascular route. In 30 patients t he aneurysm was not treated, either because of persisting grade 5 WFNS afte r SAH or because the risk of treatment appeared excessive with some complex unruptured aneurysms. A complication leading to permanent morbidity or mor tality occurred after 5 surgical and 1 endovascular procedure (8.6%). Regar ding overall management results after acute SAH, 14 of the total of 59 pati ents admitted with acute SAH died, corresponding to a management mortality of 24%. Although the present series cannot provide statistically firm conclusions, the authors believe from the actual experience and the accumulating literat ure, that the principal complementary aspect of the two treatment modalitie s is aneurysm location. Size and shape do not appear to be a primary factor to favour one or the other modality. The hope that endovascular therapy im proves the prognosis of poor grade patients with posterior circulation aneu rysms probably has been overstated. The good results of endovascular treatm ent with small narrow-necked aneurysms on proximal arteries of the posterio r circulation, as seen in the present series and as reported in the accumul ating literature, suggest that in future surgical and endovascular treatmen t should be considered as alternatives in these special cases while in larg e and broad-necked aneurysms surgery should be considered first.