V.S. Panuntsev, V.A. Pak, P.I. Nikitin, A.Yu. Ivanov, K.Yu. Orlov, L.V. Rozhchenko, V.B. Iblyaminov, M.I. Khristoforova, S.D. Razhdabov, V.A. Aliev, G.A. Asatuyan, N.E. Ivanova, G.P. Blagorasumova, K.I. Sebelev
(Polenov Research Neurosurgical Institute, Saint Petersburg)
Introduction. Aneurysms of the vertebrobasilar region account for 5-12% of all aneurysms of other localization. Aneurysms of the basilar artery are most frequent. However, the results of their clipping cannot be considered quite satisfactory. Thus, it seems reasonable to estimate efficacy of embolization of such aneurysms with up-to-date detachable coils.
Methods. In 1997-2005 intravascular operations were performed in 24 cases with aneurysms of the basilar artery. They were giant in 8 patients. Embolization was made with mechanically detachable Balt coils (15 cases), hydraulically detachable Cordis coils (8) and the coil, combined with the Balt balloon-catheter (1 case). Efficacy of aneurysm exclusion was evaluated immediately after operation or in the nearest postoperative period. Total-subtotal embolization was considered to be radical. Exclusion of aneurysm in all other cases was regarded to be partial. A clinical outcome was assessed on admission on the basis of the Glasgow Coma Scale (5 grades). Catamnesis data were not taken into consideration (it will be an object of further study).
Results. There were 31 interventions, performed in 24 patients. Causes of reoperation were as follows: anatomic peculiarities of vessels (looping, bending, atherosclerotic changes of major vessels) – 4 cases, geometric peculiarities of aneurysms – 2 patients. Radical exclusion of aneurysm from blood flow was achieved in 16 cases; 1 patient died (Glasgow Coma score of 1). An outcome was favorable in all the rest cases (Glasgow Coma score of 4-5). Postoperative embolic complications with development of persistent neurological disorders (areflexia) were watched in 2 patients; 6 cases developed vascular spasm as a response to intravascular manipulations, but it was accompanied by transient neurological disturbances only in 2 of them (amaurosis, homonymous hemianopsia, which regressed completely after papaverine administration). A number of operations, performed in 8 patients with giant aneurysms, was 11. Subtotal exclusion of aneurysms was attained in 5 cases. A considerable volume of aneurysm was a cause of impaired liquor discharge and hydrocephalus development in 5 cases; it demanded ventriculoperitoneal shunting in 2 of them. According to rather scanty catamnestic information, 1 case with partial exclusion of aneurysm developed repeated hemorrhage 5 months later.
Conclusion. Preliminary data are indicative of efficacy of intravascular operations in patients with aneurysms of the basilar artery. Total-subtotal embolization can be achieved in the majority of cases, including a considerable part of those with big and giant aneurysms. Operation efficacy is dependent on a choice of intravascular instruments. Despite the reassuring nearest outcomes and satisfactory results of angiographic examination, carried out immediately after operation, stability of full-value exclusion of aneurysm from blood flow and especially reliability of preventing repeated hemorrhages demand catamnestic confirmation, based on a large amount of statistical data.