A comparison between endovascular and surgical management of basilar artery apex aneurysms

Object. The goal of this retrospective study was to evaluate endovascular t reatment by means of Guglielmi detachable coils (GDCs) compared with surgic al management for basilar artery (BA) apex aneurysms. Methods. Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treat ment. Of 20 patients who underwent surgery and 21 who underwent GDC emboliz ation. 15 (75%) and 11 (52%), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty four (92%) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen pat ients with unruptured or ruptured aneurysms more than 14 days post SAH were treated electively. Patients in the endovascular and surgical treatment gr oups had aneurysms with comparable dimensions and configurations. Overall, 15 (75%) of the surgical patients and 20 (95%) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAM, 11 (7 3%) of the surgical group and 10 (91%) of the endovascular group did well. Fourteen patients treated electively (93%) had good outcomes. There were tw o deaths (10%) in the surgical group and none in the endovascular group. Pa tients treated surgically were hospitalized twice as long and incurred twic e the expenses of patients who underwent endovascular treatment (p < 0.001) . Conclusions. Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long-term follow up is needed to better define the natural history of the endovascularly tre ated aneurysm and to further evaluate the accuracy of these preliminary res ults.