Objective: To evaluate the effect of surgery and conservative treatment on basilar-vertebral aneurysms.
Methods: The clinical data of 153 cases with basilar-vertebral aneurysms treated in Tiantan Hospital from Jan. 1990 to Oct. 2001 were analyzed retrospectively. Thirty-eight untreated patients with basilar-vertebral aneurysms and one patient with cerebral posterior artery aneurysms were followed up by telephone and letters for 0.42 to 7.92 years, with the mean of 1.91 years.
Results: Of the 1 232 patients with intracranial aneurysms, 153 (12.4%) cases, 88 males and 65 females, aged 2 - 69 with a mean age of 40.75 years, suffered from basilar-vertebral aneurysms. The peak of incidence was 40-50 years. One hundred and two cases (66.7%) received surgical treatment. Excellent outcome was observed in 60 cases (58.8%), good outcome in 10 (9.8%); 29 cases (28.4%) showed a bad outcome, and 3 patients died with a mortality rate of 2.9%. Fifty-one cases received conservative treatment. After the surgery, 13 cases died of rupture of aneurysms during hospitalization. Eight (61.5%) aneurysms were located in basilar artery, 2 (15.4%) in cerebral posterior artery, 1 (7.7%) in vertebral artery, 1 in basilar-vertebral junction, and 1 in cerebella inferior posterior artery. According to Hunt and Hess classification, 2 cases were considered of degree 0, 1 case degree 1, 5 cases degree 2, 1 case degree 3, and 4 cases degree 4. The age range was 5 - 69 years and the mean age was 38.69 years of the above 13 patients, 10 cases (76.9%) had previously suffered from subarachnoid hemorrhage, 2 suffered from the attack twice. 3 cases (23.1%) with unruptured aneurysms had symptoms. Among the 38 followed-up patients without surgical treatment, 3 patients (17.6%) with the mean age of 52.67 years, of which 2 had aneurysms located in basilar artery and one in cerebral posterior artery, died of aneurysm rupture 0.42, 0.72 and 1.5 years after discharging respectively. Before death two cases presented symptoms and one died accidentally.
Conclusion: Active surgical treatment effectively decreases the high mortality rate of basilar-vertebral aneurysms.