Endovascular Embolization Of Forty-six Cases With Basilar Apex Aneurysms

Objective: Retrospective analysis the results of endovascularembolization of46cases with basilar artery apex aneurysm, to evaluate thesafety and efficacy of endovascular embolization of the basilar artery apexaneurysm.Mehtods: The clinical data of53patients with top of basilar arteryaneurysm admitted to the first hospital of Jilin University department ofneurovascular surgery since2005July to2013December were collected andanalyzed, of which46cases underwent endovascular embolization.Results: Forty-six patients were performed successfully endovascularembolization, there were16male and30female. The age ranged from25to72years old, average48.5years old. There were40cases with ruptured aneurysm,6cases with unruptured aneurysms. All patients underwent CTA, MRA or DSAexamination, top of the basilar artery aneurysm was clearly diagnosed. In theabove mentioned46cases, there were18cases combined with othercerebrovascular disease, of which combined with posterior communicatingartery aneurysm in8cases, combined with middle cerebral artery aneurysm in4cases and combined with moyamoya disease in6cases. In the40cases withruptured aneurysms, CT showed different degrees of subarachnoid hemorrhage,including4cases with intraventricular hemorrhage. CTA or DSA showed theaneurysm diameter ranged from2~11mm, including16cases of <5mm,26cases were5~10mm,4cases of>10mm. There were36cases with wide neckaneurysms (more than4mm or neck of aneurysm: diameter of aneurysm wasmore than1:2). The main clinical symptoms: headache, nausea, and vomitingin35cases, sudden unconsciousness in5cases, sudden dizziness with limb dysfunction in4cases, asymptomatic unexpected discovery in2patients. Therewere39cases in grade Hunt-Hess I~II,5cases in grade Hunt-Hess III~V. Therewas only case complicated with hemorrhage during operation, the rest weresuccessfully embolization. There were8cases underwent coil embolization，38cases underwent embolization assisted by stents. The aneurysm embolism ratereached100%in36cases (78.2%), more than90%embolism in8casas(17.3%), less than90%embolism in2cases (4.3%).There was one casecomplicated with top of the basilar artery syndrome, there was no death case.On discharge, there are42patients in prognosis GOS score of5points,4cases(9.9%)in4points. The follow-up ranged from6months to22months, average(16.6+2.8) months, there was no change in39cases compared with previousembolization, recurrence occurred in5cases, died after one year in1case, lossto follow-up in1case.Conclusion:Endovascular treatment is a safe and effective method in the treatment ofbasilar apex aneurysm, few complications, good outcome, low mortality, but atthe same time there is a potential risk, such as cerebral vascular spasm,ischemia and otherwise serious consequences.