기저동맥 분지부 동맥류의 치료결과

Management Outcomes of Basilar Bifurcation Aneurysms

  • 안재성 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 김정훈 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 권양 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 권병덕 (울산대학교 의과대학 서울중앙병원 신경외과학교실)
  • Ahn, Jae Sung (Department of Neurological Surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Jung Hoon (Department of Neurological Surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kwon, Yang (Department of Neurological Surgery Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kwun, Byung Duk (Department of Neurological Surgery Asan Medical Center, College of Medicine, University of Ulsan)
  • 투고 : 2000.01.16
  • 심사 : 2000.05.10
  • 발행 : 2000.07.28

초록

Objective : The authors analyzed the results of management outcomes for basilar bifurcation aneurysms treated with transcranial surgery and endovascular surgery. Methods : At the authors' institution between May 1989 and December 1998, 47 aneurysms with 45 patients were treated with transcranial surgery including surgical clipping/wrapping and endovascular surgery for basilar bifurcation aneurysms. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Of the 45 patients, 87 percent of the aneurysms were ruptured and 13% unruptured. Forty six percent of the patients had multiple aneurysms including basilar bifurcation aneurysm. Of the 39 patients with subarachnoid hemorrahge, 77% were in good neurological status(Hunt Hess grade I-III), 23% were in poor grade(H-H grade IV-V). Thirty two patients were treated with transcranial surgery and 15 patients were treated with endovascular surgery. Two patients who had treated with wrapping surgery later bled during follow-up period and treated with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I 66%, GOS II 12.5%, GOS III 6.3%, GOS IV 6.3% and GOS V(death) 9.4%. The major causes of morbidity related to transcranial surgery were perforator occlusion, vasospasm and retraction injury. The management outcome of the endovascular surgery was : GOS I 66.7%, GOS II 6.7%, and GOS V 26.7%. The major causes of mortality related to endovascular surgery were related to intraoperative aneurysmal bleeding. Conclusion : This report documents that more than 75% of patients undergoing treatment either transcranial or endovascular surgery can expect good clinical outcomes. Treatment modality in management of basilar bifurcation aneurysm must be carefully selected based on various considering factors.

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