Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Outcomes of Large (>10 mm) Unruptured Posterior Circulation Aneurysms and Their Predictors

  • Byun, Joonho (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Wonhyoung (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jung Cheol (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Jae Sung (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.02.04
  • Accepted : 2020.05.12
  • Published : 2021.01.01
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Abstract

Objective : The treatment of large aneurysms of the posterior circulation is complicated and remains challenging. We here analyzed our institutional clinical outcomes of large unruptured aneurysms of the posterior circulation. Methods : This study included 56 patients who presented with a large (>10 mm) unruptured aneurysm of the posterior circulation between 2002 and 2018. Results : There were 18 (32.1%) male and 38 (67.9%) female patients, with a mean age of 53.4 years. The most common location was the vertebral artery, followed by the basilar tip and posterior cerebral artery. The median follow-up duration was 29 months. Eighteen patients (32.1%) were treated by transcranial surgery and 38 (67.9%) were treated by endovascular treatment (EVT). Post-treatment complications occurred in 16 patients (28.6%), with there being no significant difference between the transcranial surgery and EVT groups. Complete obliteration was achieved in 30 patients (53.6%), with there being no statistically significant difference between the transcranial surgery and EVT groups. Recurrence occurred in 17 patients (30.4%), and the rate of recurrence was higher in the EVT group than in the transcranial surgery group (39.5% vs. 11.1%, p=0.03). Forty-four (84%) of 56 patients showed a favorable functional outcome. In saccular aneurysm, EVT was negative predictor of worsening of functional status. Conclusion : Treatment of these aneurysms harbors an inherent high risk of morbidity. No superiority was found between transcranial surgery and EVT in terms of complications and complete obliteration, but transcranial surgery showed a higher treatment durability than EVT.

Keywords

Acknowledgement

We appreciate to Prof. Byung Duk Kwun who is our eternal teacher, founder of cerebrovascular surgery section of AMC Neurosurgery and great neurosurgeon. We always remember his teaching, attitude of neurosurgeon, and life philosophy. We were his students, now we are great honored to be able to work as his colleagues. We also thank Jeong Hyun Oh, a rhinologist in Daejeon (Coen Clinic), who gave us valuable advice and help.

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