Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich School of Medicine, Munich, Germany.
Department of Diagnostic and Interventional Neuroradiology, Helios Klinikum München West, Munich, Germany.
Acta Neurochir (Wien). 2020 Jun;162(6):1343-1351. doi: 10.1007/s00701-020-04304-x. Epub 2020 Apr 4.
Fusiform vertebrobasilar aneurysms (FVBAs) may exhibit a disastrous clinical course. Due to their rare occurrence, evidence concerning optimal management is lackluster.
To describe the epidemiology, clinical features and treatment outcomes of a consecutive series of patients admitted to our institution.
We retrospectively evaluated patient charts with respect to clinical presentation, treatment procedures, and the outcomes of all patients diagnosed with an FVBA, which were seen at our institution between March 2006 and February 2017.
Forty-five consecutive patients were analyzed. Follow-up was available for 39 patients (86.7%) with a median duration of 28.8 months. Seventeen patients (37.7%) were asymptomatic, 14 patients (31.1%) presented with brainstem ischemia, 8 patients (17.8%) with supratentorial ischemia, and 3 (6.7%) patients with brain stem compression. Aneurysm rupture occurred in 3 patients upon presentation (6.7%). Initially, 19 patients (42.2%) were significantly disabled with Modified Rankin Scale (mRS) scores ≥ 3. Twelve patients (26.7%) underwent invasive treatment: endovascular therapy in 9 cases and surgical treatment in 3 cases. Thirty-three patients received conservative treatment. During follow-up, 6 events (66.7%) of severe disability or death (mRS 4-6) occurred in the endovascular group versus 1 event (33%) in the surgical group versus 19 events (63.3%) among conservatively treated aneurysms. Deterioration was significantly more frequent in patients with symptomatic aneurysms (p = 0.030).
Patients harboring an FVBA frequently present with disabling symptoms caused by various pathomechanisms. The natural history is aggressive, mostly for initially symptomatic aneurysms, and periprocedural morbidity of surgical or endovascular treatment remains substantial.
梭形椎基底动脉动脉瘤（FVBA）可能表现出灾难性的临床病程。由于其罕见发生，缺乏关于最佳治疗方法的证据。
描述连续系列患者的流行病学、临床特征和治疗结果，这些患者在我院就诊并被诊断为 FVBA。
我们回顾性评估了患者病历，记录了所有患者的临床表现、治疗程序和结果，这些患者在我院就诊的时间为 2006 年 3 月至 2017 年 2 月之间。
连续分析了 45 例患者。39 例患者（86.7%）获得了随访，中位随访时间为 28.8 个月。17 例患者（37.7%）无症状，14 例患者（31.1%）表现为脑干缺血，8 例患者（17.8%）表现为幕上缺血，3 例患者（6.7%）表现为脑干压迫。3 例患者在就诊时发生了动脉瘤破裂（6.7%）。最初，19 例患者（42.2%）的改良 Rankin 量表（mRS）评分≥3，严重残疾。12 例患者（26.7%）接受了有创治疗：9 例患者接受了血管内治疗，3 例患者接受了手术治疗。33 例患者接受了保守治疗。在随访期间，血管内治疗组发生了 6 例（66.7%）严重残疾或死亡（mRS 4-6）事件，手术治疗组发生了 1 例（33%）事件，保守治疗组发生了 19 例（63.3%）事件。有症状的动脉瘤患者的病情恶化明显更频繁（p=0.030）。
患有 FVBA 的患者经常出现由各种发病机制引起的致残症状。其自然病史是侵袭性的，主要是对于最初有症状的动脉瘤，手术或血管内治疗的围手术期发病率仍然很高。
