1140. Microsurgical Treatment for Complex Basilar Artery Aneurysms with Long-Term Follow-Up: a series of 40 cases

Authors: Xiang'en Shi (Beijing, China)

Introduction: There has been a massive shift in the balance toward endovascular therapy for basilar artery (BA) aneurysms in the modern era. Methods: We retrospectively reviewed clinical and radiologic data from patients with BA aneurysms who were treated in a single medical center from August 2006 to May 2018. Results: Forty consecutive patients with 46 aneurysms during the 12-year period were included. The rate of complete aneurysm occlusion in 40 cases using a 1-stage operation was 60.0% (23/39). The graft patency rates of 17 bypass surgeries were 88.2% (15/17) within 1 week and 76.5% (13/17) at 3 months after surgery. The mean 3-year outcome was favorable (modified Rankin Scale score 0-2) for 32 patients (80%) and poor (modified Rankin Scale score 3-5) for 5 patients (12.5%), and 3 patients died (7.5%). The survival for patients with BA apex aneurysms was higher than the survival observed for patients with BA trunk/vertebrobasilar junction aneurysms. Conclusion: Microsurgical treatments for BA aneurysms can be effective, with good patient outcomes after operation. Patients with wide-necked, fusiform, or dolichoectatic aneurysms seem to exclude the aneurysm, preventing unnecessary retreatments with bypass techniques. The potential for a poor prognosis of patients with BA trunk/vertebrobasilar junction aneurysms was higher than that for patients with basilar apex aneurysms who presented with unfavorable subsequent events.