Clinical Study On Therapeutic Strategies Of Vertebrobasilar Aneurysms

Objective:1. To analysis clinical feathers of vertebrobasilar aneurysms;2. To analysis factors effecting therapeutic effect of vertebrobasilar aneurysms;3. To study the indicators and therapeutic strategies of various therapeutic methods by comparation.Methods:Cases of 35 patients with vertebrobasilar aneurysms diagnosed and treated in our department during Feb 2006 to Jan 2011 were collected, including general information, symptoms and signs, imaging findings, therapeutic methods and effects. Conditions and imaging findings reexamined were also collected. There were 37 aneurysms in 35 patients, including 16 basilar aneurysms,14 cases of vertebral aneurysms with 16 aneurysms, one case of superior cerebellar artery (SCA) aneurysm, one case of anterior inferior cerebellar artery (AICA) aneurysm and 3 cases of posterior inferior cerebellar artery (PICA) aneurysms. There were 14 saccular aneurysms,20 dissecting aneurysms and 3 fusiform aneurysms. Twelve of 16 vertebral aneurysms were located in the origination of PICA, including 3 aneurysms proximal to the orificia of PICA (pre-PICA type),4 on the orificia of PICA (in-PICA type), and 5 distal to the orificia of PICA (post-PICA type).Over the 35 cases,9 had unruptured aneurysms.7 showed ischemic symptoms, while the other 2 presented with oppression signs. Nine were treated conservatively for various reasons, four treated surgically, and 23 aneurysms in 22 patients received endovascular management. Over these received endovascular management, Seven were embolized with coil,8 treated with stent-assistant coil embolization,5 treated with parent artery occlusion, and 3 in 2 patients were managed with sole stent.Results:1. Modified Rankin Scales at discharge varies by Hunt-Hess grade. Prognosis of Hunt-Hess gradeâ…¡is better than gradeâ…¢,â…£, andâ…¤.2. Immediate angiography after endovascular management showed lower ratio of complete embolization in dissecting aneurysms than in saccular aneurysms.3. Comparing different endovascular treatment methods via follow-up angiography, the effect of parent artery occlusion is reliable, while the recurrence rate of stent-assistant embolization.Conclusion:1. There is high severity in vertebrobasilar aneurysms, which are liable to influence brain stem, resulting in instability of vital signs.2. Over various factors effecting therapeutic effects, the location and form of aneurysm, severity of hemorrhage onset, and therapeutic methods are the major. Dissecting aneurysms and aneurysms with high Hunt-Hess grade have poor prognosis.3. It is the shape, compensatory supplement of collateral supplies, and existence of important branches who determains how we deal with aneurysms.Coil embolization is effective in saccular aneurysms with narrow neck, while a stent is efficient in dissecting, fusiform, and saccular aneurysms with wide neck. Sole stent treatment has nice results in some cases of dissecting and fusiform aneurysms, but intimately follow-up is needed.The choice of management of aneurysms form the origination of PICA determains on the contralateral vertebral artery. Good contralateral supply supports parent artery occlusion, in order to prevent re-rupture, While stent is essential if contralateral supply cannot afford the supplyment of posterior circulation.