Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms

Neurosurgery. 2013 May;72(5):763-75; discussion 775-6. doi: 10.1227/NEU.0b013e3182870703.


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.

Conclusion: Vertebrobasilar aneurysms are challenging lesions with limited microsurgical or endovascular options. Despite aggressive surgical treatment, the long-term outcome remains poor for most patients.

MeSH terms

  • Adult
  • Aged
  • Basilar Artery / surgery*
  • Blood Vessel Prosthesis / adverse effects*
  • Cerebral Revascularization / adverse effects*
  • Endovascular Procedures / adverse effects*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents / adverse effects*
  • Treatment Outcome
  • Vertebral Artery / surgery*