Introduction: A paucity of patients with ruptured basilar apex aneurysms have been analyzed with long-term clinical results.
Methods: Sixty-one consecutive ruptured basilar apex aneurysms from 2005-2011 were retrospectively reviewed. A team-oriented approach was used to decide treatment. Clipping was typically used in younger patients, those with a complex neck anatomy, or when the origin of PCA was from the aneurysmal sac.
Results: Demograhics and Outcome:
Coiling Group ( n=39 or 64%): The average age was 57 with a Hunt and Hess grade (HH) 3.3. At discharge 10% had died, 33% had a poor outcome (mRS3-5) and 57% had a good outcome (mRS0-2). Analyzing survivors, drastic long term improvement was noted. At three months, 78% of these patients were a mRS 0-2 which improved to 87% by one year.
Clipping group ( n=22 or 36%): The average age was 49 with a HH grade of 2.6. At discharge 14% had died, 27% had a poor outcome and 59% had a good outcome. Analyzing the survivors, dramatic improvement was seen. At three months, 82% of these patients were a mRS 0-2 which improved to 86% at one year. Eight out of 22 (37%) patients had post-operative 3rd nerve palsies. All but one resolved at longest follow up.
Radiographic outcome: After initial coiling, 59% achieved a Raymond 1, 36% Raymond 2, and 2.5% Raymond 3. 11/15 Raymond 2 or 3 patients had long term follow up. In this group, 46% had stable disease that did not require treatment, 27% spontaneously resolved, and 27% required re-treatment. One patient (4.5%) in the Clipping group had a residual stable lesion at one year.
Conclusions: By using a team-oriented approach, both clipping and coiling of ruptured basilar apex aneurysms provided excellent long term outcomes with >85% of survivors reaching a good outcome by one year.
Patient Care: Hopefully the good outcomes with both modalities will encourage the referral of ruptured basilar apex aneurysms to high volume centers where expertise in both endovascular coiling and microsurgical clipping are available.
Learning Objectives: By the conclusion of this session participants should be able to discuss the indications and role of clipping vs. coiling in ruptured basilar tip aneurysms, as well as expected outcomes and need for angiographic follow-up.