A Comparative Analysis of Endovascular Coiling and Surgical Clipping of Upper Basilar Artery Aneurysms.

Jung, Sang Myung; Jang, Suk Jung

Original Article

Journal of Korean Neurosurgical Society 2004;36(4): 306-309.

Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea. chosunns@hanmail.net

ABSTRACT

OBJECTIVE
Despite advances in both operative techniques (endovascular coiling or surgical neck clipping), management of basilar artery aneurysms has not been completed. The goal of this retrospective study is to evaluate endovascular coiling compared with surgical neck clipping of upper basilar artery aneurysms. METHODS: From january of 1990 to December of 2001, the authors treated 31 cases of upper basilar artery aneuryms. Among of those upper basilar artery aneurysms, 22 patients received surgical neck clipping and 9 patients recevied non-surgical endovascular coiling. Results from outpatient follow-ups for 12 months after operation were classified with Glasgow outcome scale (GOS) analyzed respectively. RESULTS: Overall, 11(50%) of the surgical neck clipping patients and 6(66.7%) in endovascular coiling patients were showed good outcomes(GOS 4~5). Morbidity of the surgical clipping is about 22.7%(5/22) and the endovascular coiling is about 22.2%(2/9) There were two death in the surgical clipping group due to vasospasm and brain stem infarction, but none in the endovascular coiling group. The major causes of surgical morbidity were direct brain damage, perforator occlusions, vasospasm and meningitis. Endovascular coiling group was shorter hospital stay and lesser hospital expenses than surgical neck clipping group. CONCLUSION: Non-surgical endovascular coiling of upper basilar artery aneurysms is considered to be useful alternative treatment in improving short-term prognosis(12 months follow-ups) and reducing medical expenses compared to surgical neck clipping although long-term follow-up is needed.

Key Words: Basilar artery aneurysm; Surgical clipping; Endovascular coiling