Posterior Fossa Craniectomy with Endovascular Therapy of Giant Fusiform Basilar Artery Aneurysms: A New Approach to Consider?

Autor: Dorian Chauvet, Aymeric Amelot, Olivier Bekaert, Michel Piotin, Stanislas Smajda, Hocine Redjem, Adrien Simonneau, Louis-Marie Terrier, Guillaume Lot
Rok vydání: 2017
Předmět:
Male
Decompressive Craniectomy
medicine.medical_specialty
Tomography Scanners
X-Ray Computed
medicine.medical_treatment
Vertebral artery
Pilot Projects
Statistics
Nonparametric
Magnetic resonance angiography
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
medicine.artery
Occlusion
Basilar artery
Humans
Medicine
cardiovascular diseases
Posterior communicating artery
Aged
Retrospective Studies
Aged
80 and over
medicine.diagnostic_test
business.industry
Endovascular Procedures
Intracranial Aneurysm
Magnetic resonance imaging
Middle Aged
Magnetic Resonance Imaging
Confidence interval
Surgery
Cranial Fossa
Posterior
Case-Control Studies
Female
Decompressive craniectomy
Neurology (clinical)
business
Magnetic Resonance Angiography
030217 neurology & neurosurgery
Zdroj: World Neurosurgery. 98:104-112
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2016.10.119
Popis: The prognosis of unruptured giant basilar artery (BA) aneurysms is very poor. No treatment has shown efficacy in survival. This pilot case-control study examines the overall survival (OS) benefit of combined surgical and endovascular management of giant BA aneurysms.Combined treatment including posterior fossa craniectomy followed by endovascular treatment was performed in 3 patients with giant BA aneurysms. OS of the 3 patients was compared with a control group of 6 patients (ratio 1:2) treated with the endovascular procedure only.The mean survival time was 32.6 months in the craniectomy group (SD 9.01, 95% confidence interval [14.9, 50.3]) and 3.5 months in the control group (SD = 2.08, 95% confidence interval [0.001, 7.6]; Mantel-Cox test P0.04). At mean follow-up of 36.5 months (SD 10.2), 2 of 3 patients had a favorable outcome with a Glasgow Outcome Scale score of 5. Univariate analysis determined that women had a statistically higher OS than men (33.7 months vs. 3.058 months for men; log-rank test P = 0.011). A similar outcome was obtained in the presence of a circulating posterior communicating artery (P = 0.03) and in the presence of an endovascular right vertebral artery occlusion (P = 0.022).Our study suggests that preventive posterior fossa craniectomy increases significantly OS of patients with giant BA aneurysms.
Databáze: OpenAIRE
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