title: Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes.
abstract: OBJECTIVE Fusiform dolichoectatic vertebrobasilar aneurysms are rare, challenging lesions. The natural history of these lesions and medium- and long-term patient outcomes are poorly understood. The authors sought to evaluate patient prognosis after diagnosis of fusiform dolichoectatic vertebrobasilar aneurysms and to identify clinical and radiographic predictors of neurological deterioration. METHODS The authors reviewed multiple, prospectively maintained, single-provider databases at 3 large-volume cerebrovascular centers to obtain data on patients with unruptured, fusiform, basilar artery dolichoectatic aneurysms diagnosed between January 1, 2000, and January 1, 2015. RESULTS A total of 50 patients (33 men, 17 women) were identified; mean clinical follow-up was 50.1 months and mean radiographic follow-up was 32.4 months. At last follow-up, 42% (n = 21) of aneurysms had progressed and 44% (n = 22) of patients had deterioration of their modified Rankin Scale scores. When patients were dichotomized into 2 groups- those who worsened and those who did not-univariate analysis showed 5 variables to be statistically significantly different: sex (p = 0.007), radiographic brainstem compression (p = 0.03), clinical posterior fossa compression (p < 0.001), aneurysmal growth on subsequent imaging (p = 0.001), and surgical therapy (p = 0.006). A binary logistic regression was then created to evaluate these variables. The only variable found to be a statistically significant predictor of clinical worsening was clinical symptoms of posterior fossa compression at presentation (p = 0.01). CONCLUSIONS Fusiform dolichoectatic vertebrobasilar aneurysms carry a poor prognosis, with approximately one-half of the patients deteriorating or experiencing progression of their aneurysm within 5 years. Despite being high risk, intervention-when carefully timed (before neurological decline)-may be beneficial in select patients.
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: David S
authors.initials: DS
authors.lastname: Xu
authors.affiliation: Departments of2Neurological Surgery and.|3Radiology, University of Washington, Seattle, Washington; and.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: M Yashar S
authors.initials: MYS
authors.lastname: Kalani
authors.affiliation: 4Department of Neurological Surgery, State University of New York at Buffalo, New York.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Celene B
authors.initials: CB
authors.lastname: Mulholland
authors.affiliation: Departments of2Neurological Surgery and.
authors.forename: Isaac J
authors.initials: IJ
authors.lastname: Abecassis
authors.affiliation: Departments of2Neurological Surgery and.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.affiliation: Departments of2Neurological Surgery and.
authors.forename: John D
authors.initials: JD
authors.lastname: Nerva
authors.affiliation: 4Department of Neurological Surgery, State University of New York at Buffalo, New York.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: 4Department of Neurological Surgery, State University of New York at Buffalo, New York.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.affiliation: 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000000981:diagnostic imaging; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
keywords: CI = confidence interval; CN = cranial nerve; OR = odds ratio; SAH = subarachnoid hemorrhage; TIA = transient ischemic attack; basilar artery; dolichoectasia; fusiform aneurysm; intracranial aneurysm; mRS = modified Rankin Scale; stroke; vascular disorders