Journal ArticleDOI
Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients.
Laligam N. Sekhar,Farzana Tariq,Ryan P. Morton,Basavaraj Ghodke,D Hallam,Jason Barber,Louis J. Kim +6 more
TLDR
In the current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences.Abstract:
Background Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms. Objective We describe the variables our center evaluates when choosing to clip or coil basilar tip aneurysms and our outcomes. Four case illustrations are presented. Methods All patients with ruptured or unruptured basilar tip aneurysms from 2005 to April 2012 were examined. The patients were treated by 2 interventional neuroradiologists and 2 dually trained neurosurgeons. Results There were 63 ruptured (clipped 38%, coiled 62%) and 37 unruptured (clipped 35%, coiled 65%) aneurysms in this 100-patient study. Seventy percent of the patients with ruptured aneurysms and 92% of the patients with unruptured aneurysms had a good outcome (modified Rankin scale 0-2) at 3 months. For ruptured aneurysms, there was a statistically significant difference in clipping and coiling with respect to age and treatment modality (clip 48.8 years, coil 57.6 years). Patients in the coiled group had higher dome-to-neck (1.3 vs 1.1) (P = .01) and aspect ratios (1.6 vs 1.2) (P = .007). In the ruptured coiling group, 69.5% achieved a Raymond 1 radiographic outcome, 28% Raymond 2, and 2.5% Raymond 3. Eleven (17.4%) patients required re-treatment, and 3 (4.4%) patients were re-treated more than twice. Coiling of unruptured aneurysms resulted in 75% Raymond 1. There were no residual lesions for unruptured clipped aneurysms. There were no differences in outcome between clipping and coiling in the ruptured and unruptured group. Conclusion In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment.read more
Citations
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Journal ArticleDOI
Multimodality treatment of complex unruptured cavernous and paraclinoid aneurysms.
Louis J. Kim,Farzana Tariq,Michael R. Levitt,Jason Barber,Basavaraj Ghodke,Danial K. Hallam,Laligam N. Sekhar +6 more
TL;DR: Treatment of unruptured cavernous and paraclinoid internal carotid artery aneurysms proximal to the posterior communicating artery treated at a single center with multimodal treatment can be carried out with acceptable rates of morbidity.
Journal ArticleDOI
Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta-analysis of randomized and non-randomized trials with short- and long-term follow-up
Alberto Falk Delgado,Tommy B. Andersson,Tommy B. Andersson,Tommy B. Andersson,Anna Falk Delgado,Anna Falk Delgado +5 more
TL;DR: This meta-analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiled.
Journal ArticleDOI
Factors Determining Surgical Approaches to Basilar Bifurcation Aneurysms and Its Surgical Outcomes
Mardjono Tjahjadi,Juri Kivelev,Joseph C. Serrone,Hidetsugu Maekawa,Oleg Kerro,Behnam Rezai Jahromi,Hanna Lehto,Mika Niemelä,Juha Hernesniemi +8 more
TL;DR: Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO.
Journal ArticleDOI
Treatment of wide-neck basilar tip aneurysms using the Web II device.
Ruben Colla,Luigi Cirillo,C Princiotta,M Dall’Olio,Federico Menetti,Stefano Vallone,Marco Leonardi +6 more
TL;DR: This study reports the experience with WEB II, a new embolization device employed in four patients with wide-necked basilar tip aneurysms, a subset of deep vein thrombosis that continues to pose technical challenges in treatment.
Journal ArticleDOI
Should we still consider clips for basilar apex aneurysms? A critical appraisal of the literature.
TL;DR: Both microsurgical and endovascular approaches should be complementing each other to treat basilar apex aneurysms, as many indications still exist for the use of microsurgery.
References
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Journal ArticleDOI
Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment
TL;DR: Patients' age was a strong predictor of surgical outcome, and the size and location of an aneurysm predict both surgical and endovascular outcomes.
Journal ArticleDOI
International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion
Andrew J. Molyneux,Richard S. C. Kerr,Ly-Mee Yu,Mike Clarke,Mary Sneade,Julia A. Yarnold,Peter Sandercock +6 more
TL;DR: In patients with ruptured intracranial aneurysms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival benefit continues for at least 7 years.
Journal ArticleDOI
The Barrow Ruptured Aneurysm Trial
Cameron G. McDougall,Robert F. Spetzler,Joseph M. Zabramski,Shahram Partovi,Nancy K. Hills,Peter Nakaji,Felipe C. Albuquerque +6 more
TL;DR: Although a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes at 1 year, it remains important that high-quality surgical clipping be available as an alternative treatment modality.
Journal ArticleDOI
Outcomes of Early Endovascular Versus Surgical Treatment of Ruptured Cerebral Aneurysms: A Prospective Randomized Study
Timo Koivisto,Ritva Vanninen,Heleena Hurskainen,Tapani Saari,Juha Hernesniemi,Matti Vapalahti +5 more
TL;DR: One-year clinical and neuropsychological outcomes seem comparable after early surgical and endovascular treatment of ruptured intracranial aneurysms, and the long-term efficacy of endov vascular treatment in preventing rebleeding remains open.
Journal ArticleDOI
Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial
Joseph M. Eskridge,Joon K. Song +1 more
TL;DR: Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management.