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CONTACT: 847/378-0517Heather Monroe ([email protected])
Neurosurgeons Compare Endovascular and Surgical Treatment of Aneurysms
CHICAGO (April 8, 2002) -Neurosurgeons are routinely presented with the task of determining the best possible treatment options for patients with brain aneurysms. Basilar apex aneurysms (situated at the base or at the tip of the basilar artery, a vessel in front of the brainstem) are one of the most challenging aneurysms to treat surgically. The comparison between treatment of this type of brain tumor using endovascular versus surgical methods has been reviewed in a recent study, "Comparison of Endovascular and Surgical Treatment of Basilar Apex Aneurysms," which will be presented by Gordon Tang, MD; Eric Hanley, MD; C. Michael Cawley, MD; Harry Cloft, MD, PhD; Jacques Dion, MD and Daniel F. Barrow, MD, on Wednesday, April 10, from 9:45 to 11:15 a.m., during the 70th Annual Meeting of the American Association of Neurological Surgeons (AANS).
In this study the authors directly compare endovascular and surgical management of basilar apex aneurysms by examining patients with aneurysm locations that were treated during the same period of time and within the same institution. Patients underwent the same anesthesia and critical care.
From January 1995 to December 2000, 31 patients with basilar apex aneurysms underwent surgery. During the same period of time, 38 patients with basilar apex aneurysms underwent endovascular treatment with the use of GDC (Guglielmi detachable coils). An analysis and review were undertaken of the outpatient charts, the operative report, and all angiographic, computed tomographic (CT), and magnetic resonance (MR) studies.
Outcome was measured with the Glasgow Outcome Scale (GOS) in which GOS I corresponds to good recovery and resumption of normal life despite minor deficits, GOS II to a moderately disabled but independent patient, GOS III to a severely disabled (but conscious) patient who is dependent on others for daily support, GOS IV to a persistently vegetative state, and GOS V to death. In both surgical and endovascular cases, additional clinical data was obtained from neurological examinations.
The endovascular group (treated with GDC) had a mean age of 57 years as compared to 49 years for the surgical group. In the endovascular group, there were six surgical complications for a rate of 19.4 percent. Of 38 endovascular cases, 24 had angiographic follow-up averaging sixteen months. Of the 14 patients without follow-up, seven did not receive long-term follow-up because they had died. In the endovascular group, eight patients died with a mortality rate of 21 percent. In the surgical group, five patients died with a mortality rate of 16 percent. As a result, 65 percent of patients in the endovascular group had good or excellent functional outcomes. In the surgical group, 57 percent had good or excellent outcomes. Endovascular and surgical management demonstrated no significant difference in functional outcome.
When using an endovascular procedure like GDC, unlike surgery, there is no need for brain or cranial nerve retraction and the possibility of occlusion of a perforating artery is minimized due to better visualization. However, durability of endovascular treatment continues to be a concern. During the relatively short follow-up, recurrence of aneurysms that required further treatment occurred in two of the 24 patients eligible for follow-up.
"A long history of assessing the durability of surgical treatment and lack of aneurysm regrowth in this study continues to suggest that surgical treatment may provide a more permanent cure," said Gordon Tang, MD, an author of the study and AANS member. "However, both surgical and endovascular treatment can result in good long-term functional outcome. In this study, greater than 60 percent of patients enjoy good or excellent long-term outcome."
This study illustrates that basilar apex aneurysms are complex lesions that are best managed by a multi-disciplinary approach tailored to the individual. Neither surgery nor endovascular management are superior to one another but instead, some lesions are more amenable to one than the other. In this series, surgery was generally reserved for more complex, higher risk aneurysms, which were frequently not amenable to endovascular management. Patients with minimal symptoms and simpler lesions tended to receive endovascular treatment. Both means of treatment can provide excellent long-term outcome.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 5,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.
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Media Representatives: If you would like to cover the meeting or interview a neurosurgeon - either on-site or via telephone - please contact the AANS Communications Department at (847) 378-0517 or call the Annual Meeting Press Room beginning Monday, April 8 at (312) 949-3201 (3202).
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