Posterior Fossa Craniectomy with Endovascular Therapy of Giant Fusiform Basilar Artery Aneurysms: A New Approach to Consider?
BACKGROUND
The prognosis of unruptured giant basilar artery (BA) aneurysms is very poor. No treatment has shown efficacy in survival. This pilot case-control study examines the overall survival (OS) benefit of combined surgical and endovascular management of giant BA aneurysms.


METHODS
Combined treatment including posterior fossa craniectomy followed by endovascular treatment was performed in 3 patients with giant BA aneurysms. OS of the 3 patients was compared with a control group of 6 patients (ratio 1:2) treated with the endovascular procedure only.


RESULTS
The mean survival time was 32.6 months in the craniectomy group (SD 9.01, 95% confidence interval [14.9, 50.3]) and 3.5 months in the control group (SD = 2.08, 95% confidence interval [0.001, 7.6]; Mantel-Cox test P < 0.04). At mean follow-up of 36.5 months (SD 10.2), 2 of 3 patients had a favorable outcome with a Glasgow Outcome Scale score of 5. Univariate analysis determined that women had a statistically higher OS than men (33.7 months vs. 3.058 months for men; log-rank test P = 0.011). A similar outcome was obtained in the presence of a circulating posterior communicating artery (P = 0.03) and in the presence of an endovascular right vertebral artery occlusion (P = 0.022).


CONCLUSIONS
Our study suggests that preventive posterior fossa craniectomy increases significantly OS of patients with giant BA aneurysms.
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. Electronic address: aymmed@hotmail.fr.
Aymeric
A
Amelot
Department of Interventionnal Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Stanislas
S
Smajda
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Louis-Marie
LM
Terrier
Department of Interventionnal Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Hocine
H
Redjem
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Adrien
A
Simonneau
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Olivier
O
Bekaert
Department of Interventionnal Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Michel
M
Piotin
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Guillaume
G
Lot
Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Dorian
D
Chauvet
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015898:Tomography Scanners, X-Ray Computed
Basilar artery; Craniectomy; Fossa posterior; Giant aneurysm; Neurovascular