Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study.

Autor:	Rezai Jahromi B; Departments of1Neurosurgery and., Dashti R; 2Department of Neurosurgery, Stony Brook University, Stony Brook, New York., Ota N; 3Sapporo Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan., Dabbagh Ohadi MA; Departments of1Neurosurgery and., Srinivasan V; 4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona., Fiorella D; 2Department of Neurosurgery, Stony Brook University, Stony Brook, New York., Kaukovalta H; Departments of1Neurosurgery and., Laakso A; Departments of1Neurosurgery and., Schwartz C; 5Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria., Kivisaari R; Departments of1Neurosurgery and., Zamotin V; Departments of1Neurosurgery and., Lindgren A; 6Department of Neurosurgery Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland., Koivisto T; 6Department of Neurosurgery Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland., Silva JM; Departments of1Neurosurgery and., Rustemi O; Departments of1Neurosurgery and., Kelahaara M; Departments of1Neurosurgery and., Jahromi BS; 7Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Killer-Oberpfalzer M; 5Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria., Potts MB; 7Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Noda K; 3Sapporo Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan., Hecker C; 5Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria., Griessenauer CJ; 5Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria., Numminen J; 8Neuroradiology, Helsinki University Hospital and University of Helsinki, Finland., Göhre F; 9Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost Halle, Germany., Andrade-Barazante H; 10Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada., Hijazy F; 9Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost Halle, Germany., Wessels L; 11Department of Neurosurgery Charité-Universitätsmedizin Berlin, Germany., Kalani MYS; 4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.; 12St. John's Neuroscience Institute, Tulsa, Oklahoma., Vajkoczy P; 11Department of Neurosurgery Charité-Universitätsmedizin Berlin, Germany., Spetzler RF; 4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona., Jääskeläinen JE; 6Department of Neurosurgery Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland., Kawashima A; 13Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan., Winkler E; 15Department of Acute Brain and Cardiovascular Injury, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy., Tähtinen O; 6Department of Neurosurgery Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland., Latini R; 15Department of Acute Brain and Cardiovascular Injury, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy., Meessen J; 15Department of Acute Brain and Cardiovascular Injury, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy., Tanikawa R; 3Sapporo Stroke Center, Sapporo Teishinkai Hospital, Sapporo, Japan., Lawton MT; 4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona., Niemelä M; Departments of1Neurosurgery and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2024 Dec 20, pp. 1-11. Date of Electronic Publication: 2024 Dec 20.
DOI:	10.3171/2024.7.JNS232341
Abstrakt:	Objective: Dolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion. The goal of this study was to define the natural history of DVBA by long-term follow-up in an international population of patients with DVBA. Methods: The authors collected data in 382 patients with DVBAs from 11 centers in Europe, the US, and Japan. The patients were followed until new ischemic or hemorrhagic stroke, symptomatic compression of the brainstem or cranial nerves, decline in modified Rankin Scale score, or death. Treatment excluded patients from further analysis. Demographic and radiological characteristics of patients were collected and a new classification was created based on the radiological characteristics of the DVBA. In total 223 patients were treated conservatively in the first phase of treatment. The data required for natural history calculations were available for 221 patients, with a cumulative follow-up of 622.3 patient-years. Kaplan-Meier and Cox regression analyses were used to assess risk factors with an influence on patient outcomes. Results: In total, 21.5% of patients were admitted due to the mass effect, and there were 67 (30%) patient deaths during follow-up, 45 (20.2%) of which were related to aneurysms. The annual mortality and morbidity were 10.8% and 1.6%, respectively. Most of the patients with DVBAs were male, although sex did not affect prognosis when compared to the radiological characteristics of the lesion. The natural history of DVBAs was also impacted by a new classification, in which an age 50 years and older predicted mortality. Furthermore, a DVBA's maximum diameter was directly proportional to adverse events. Conclusions: This study verifies the malignancy of DVBAs and encourages invasive treatment in the early phase of disease progression based on radiological characteristics and patient age when a treatment option is considered suitable. This also stresses the need for continued investigations to develop new therapeutics with acceptable safety profiles.
Databáze:	MEDLINE
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