Dolichoectatic aneurysms of the vertebrobasilar system: clinical and radiographic factors that predict poor outcomes. J Neurosurg 2018 Feb;128(2):560-566
Date
04/08/2017Pubmed ID
28387624DOI
10.3171/2016.10.JNS161041Scopus ID
2-s2.0-85041750845 (requires institutional sign-in at Scopus site) 19 CitationsAbstract
OBJECTIVE Fusiform dolichoectatic vertebrobasilar aneurysms are rare, challenging lesions. The natural history of these lesions and medium- and long-term patient outcomes are poorly understood. The authors sought to evaluate patient prognosis after diagnosis of fusiform dolichoectatic vertebrobasilar aneurysms and to identify clinical and radiographic predictors of neurological deterioration. METHODS The authors reviewed multiple, prospectively maintained, single-provider databases at 3 large-volume cerebrovascular centers to obtain data on patients with unruptured, fusiform, basilar artery dolichoectatic aneurysms diagnosed between January 1, 2000, and January 1, 2015. RESULTS A total of 50 patients (33 men, 17 women) were identified; mean clinical follow-up was 50.1 months and mean radiographic follow-up was 32.4 months. At last follow-up, 42% (n = 21) of aneurysms had progressed and 44% (n = 22) of patients had deterioration of their modified Rankin Scale scores. When patients were dichotomized into 2 groups- those who worsened and those who did not-univariate analysis showed 5 variables to be statistically significantly different: sex (p = 0.007), radiographic brainstem compression (p = 0.03), clinical posterior fossa compression (p < 0.001), aneurysmal growth on subsequent imaging (p = 0.001), and surgical therapy (p = 0.006). A binary logistic regression was then created to evaluate these variables. The only variable found to be a statistically significant predictor of clinical worsening was clinical symptoms of posterior fossa compression at presentation (p = 0.01). CONCLUSIONS Fusiform dolichoectatic vertebrobasilar aneurysms carry a poor prognosis, with approximately one-half of the patients deteriorating or experiencing progression of their aneurysm within 5 years. Despite being high risk, intervention-when carefully timed (before neurological decline)-may be beneficial in select patients.
Author List
Xu DS, Levitt MR, Kalani MYS, Rangel-Castilla L, Mulholland CB, Abecassis IJ, Morton RP, Nerva JD, Siddiqui AH, Levy EI, Spetzler RF, Albuquerque FC, McDougall CGAuthor
John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Databases, Factual
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
Magnetic Resonance Imaging
Male
Middle Aged
Nerve Compression Syndromes
Neurosurgical Procedures
Predictive Value of Tests
Prognosis
Prospective Studies
Sex Factors
Treatment Outcome
Vertebrobasilar Insufficiency
Young Adult