TY - JOUR
T1 - Dolichoectatic aneurysms of the vertebrobasilar system
T2 - Clinical and radiographic factors that predict poor outcomes
AU - Xu, David S.
AU - Levitt, Michael R.
AU - Kalani, M. Yashar S.
AU - Rangel-Castilla, Leonardo
AU - Mulholland, Celene B.
AU - Abecassis, Isaac J.
AU - Morton, Ryan P.
AU - Nerva, John D.
AU - Siddiqui, Adnan H.
AU - Levy, Elad I.
AU - Spetzler, Robert F.
AU - Albuquerque, Felipe C.
AU - McDougall, Cameron G.
N1 - Publisher Copyright:
© AANS 2018.
PY - 2018/2
Y1 - 2018/2
N2 - 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 onehalf 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.
AB - 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 onehalf 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.
KW - Basilar artery
KW - Dolichoectasia
KW - Fusiform aneurysm
KW - Intracranial aneurysm
KW - Stroke
KW - Vascular disorders
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U2 - 10.3171/2016.10.JNS161041
DO - 10.3171/2016.10.JNS161041
M3 - Article
C2 - 28387624
AN - SCOPUS:85041750845
SN - 0022-3085
VL - 128
SP - 560
EP - 566
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 2
ER -