Ruptured intracranial aneurysms with small basal outpouching: incidence of basal rupture and results of surgical and endovascular treatments.
BACKGROUND
Recognizing an aneurysmal basal rupture using angiographic evaluation is crucial for optimal treatment.


OBJECTIVE
To evaluate the incidence of a small basal outpouching (the most common angiographic configuration suggesting a basal rupture), the incidence of a ruptured basal outpouching, and the results of surgical and endovascular treatments.


METHODS
The occurrence of small basal outpouchings was determined in the initial angiographic examinations of 471 patients with a ruptured aneurysm. Information was also obtained from patient charts, surgical and interventional reports, operative video records, and reviews of radiological investigations.


RESULTS
A small basal outpouching was identified in 41 (8.7%) of the 471 ruptured aneurysms. In the surgical series (n = 286), a basal rupture was identified in 8 (30.8%) of the 26 cases of a basal outpouching and successfully treated by aneurysm clip placement. In the endovascular series (n = 185), intraprocedural aneurysm rebleeding developed in 5 of the 15 patients (33.3%) with a basal outpouching, which was most commonly observed with anterior communicating artery aneurysms.


CONCLUSIONS
The current surgical series included a 9% incidence of ruptured intracranial aneurysms with a small basal outpouching, and a 31% incidence of these basal outpouchings being identified as the rupture point. The results also suggested that endovascular coiling of a basal outpouching carries a high risk of intraprocedural aneurysm rebleeding, whereas surgical clipping is safer and provides more protection against rebleeding of aneurysms with a basal rupture.
Department of Neurosurgery, Kyungpook National University, Daegu, Republic of Korea. jparkneurosurgery@gmail.com
Jaechan
J
Park
Hyunjin
H
Woo
Dong-Hun
DH
Kang
Yongsun
Y
Kim
Seung Kug
SK
Baik
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014741:Video Recording