title: Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms.
abstract: BACKGROUND
  Giant aneurysms of the vertebral and basilar arteries are formidable lesions to treat.
  
  
  OBJECTIVE
  To evaluate the long-term outcomes of patients with vertebrobasilar aneurysms treated with extracranial-intracranial bypass and flow reduction.
  
  
  METHODS
  We retrospectively reviewed a prospective database of aneurysms cases treated between December 1993 and August 2011.
  
  
  RESULTS
  Eleven patients (8 male, 3 female) with 12 aneurysms were treated. There were 3 basilar apex aneurysms, 2 aneurysms of the basilar trunk, and 7 vertebrobasilar junction aneurysms. There were 5 saccular and 7 fusiform aneurysms. All patients underwent extracranial-intracranial bypass and vessel occlusion. Flow was reversed or reduced by complete (n = 6) or partial occlusion of the basilar artery (n = 3) or by occlusion of the vertebral arteries distal to the posterior inferior cerebellar artery (n = 3). Postoperatively (mean follow-up, 71.6 months; range, 4-228; median, 49 months), the bypass patency rate was 92.3% (12/13). The perioperative mortality rate for the initial treatment was 18.2% (2/11). In 4 cases, the aneurysms continued to grow and required further treatment; after re-treatment, 3 of these patients died. Of the initial 11 patients, 6 were treated successfully and 5 died. The mean preoperative modified Rankin Scale score was 2.1 (range, 1-3; median, 2). At last follow-up for all patients, the mean modified Rankin Scale score was 3.45 (range, 1-6; median, 3) and 2.5 (range, 1-4; median, 2.5) for the 6 long-term survivors.
  
  
  CONCLUSIONS
  Vertebrobasilar aneurysms are challenging lesions with limited microsurgical or endovascular options. Despite aggressive surgical treatment, the long-term outcome remains poor for most patients.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: M Yashar S
authors: MY
authors: Kalani
authors: Joseph M
authors: JM
authors: Zabramski
authors: Peter
authors: P
authors: Nakaji
authors: Robert F
authors: RF
authors: Spetzler
mesh_terms: D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002548:Cerebral Revascularization / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000601:surgery*