Operative or endovascular treatment of ruptured intracranial vertebral artery aneurysms?

Our purpose was to evaluate the surgical and endovascular treatment outcome s of ruptured intracranial vertebral artery aneurysms (RIVAA). The outcomes of 44 patients with RIVAA treated between 1983 and 1998 surgically (26), e ndovascularly (20) or both (2) were evaluated. The aneurysms were clipped i n 24 patients, and clipped and wrapped in two. We treated 20 by the endovas cular approach, 12 with Guglielmi detachable coils (GDC), and eight by pare nt-vessel occlusion using detachable balloons. Three patients had endovascu lar treatment after a failed or inadequate surgical attempt. Posttreatment follow-up was 17-183 months (mean 101 months) for surgically treated patien ts. For the GDC-treated group angiographic follow-up was carried at 8-49 mo nths (mean 19 months). The condition of seven (27 %) of the surgically trea ted patients worsened due to procedure-related complications, compared with 10 % in the endovascular treatment group. Of the patients initially presen ting with Hunt and Hess grade IV or V, three of five (60 %) died who were t reated surgically and two of eight (25 %) who were treated endovascularly. A good outcome was achieved in 17 surgically treated patients (85 % of the survivors) and in 16 of the endovascular group (89 % of the survivors). Thi s present "same-site" report on treatment of a specific abnormality, RIVAA, treated surgically or by an endovascular approach indicates that especiall y in poorer Hunt and Hess grade patients, the latter may offer a clinical o utcome as good as that of surgery, although long-term efficacy of GDC treat ment is still to be determined.