DOI: 10.3171/jns.1990.73.2.0165. Surgical treatment of unruptured aneurysms of the posterior circulation

Surgical treatment of unruptured aneurysms of the posterior circulation

10.3171/jns.1990.73.2.0165

Crossref journal-article

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of Neurosurgery (1754)

Abstract

✓ With the ever-increasing number of intact aneurysms revealed by modern imaging, the options for their management are assuming great importance. While some knowledge has emerged as to their natural history and the results of surgical treatment of those in the anterior circulation, little information has been published concerning unruptured aneurysms arising from the posterior circulation. The authors report their experience since 1971 with 167 patients operated on for 179 unruptured vertebrobasilar aneurysms up to 25 mm in diameter. Overall, 160 aneurysms were treated by direct clip obliteration, while 19 were managed by alternative methods. Fifty-three patients (32%) had solitary aneurysms and the other 114 patients (68%) had multiple aneurysms or an associated arteriovenous malformation, which were commonly treated concurrently. Many of these coexisting vascular anomalies had ruptured in the recent or remote past, adding to the complexity of management and interpretation of specific surgical results related to the intact posterior circulation aneurysm. There were 78 documented postoperative complications including 23 systemic complications, seven postoperative hematomas, six brain injuries from retraction, five cases of aseptic meningitis, three instances of seizures, three wound infections, and three patients with hydrocephalus. Multiple complications occurred in 23 patients. Seventy-one of the patients with these untoward events recovered, without disability, with time or treatment. There were only six poor results and one death in the series, resulting in a 4.2% combined morbidity/mortality rate. However, since two of these poor outcomes and the single death were attributable to a coexisting aneurysm, the actual surgical morbidity related specifically to the posterior circulation aneurysm was only 2.4%. This experience suggests that non-giant, intact vertebrobasilar aneurysms can be obliterated surgically at a very low risk, and this treatment should eliminate the greater lifetime risk related to an unsecured aneurysm.

Bibliography

Rice, B. J., Peerless, S. J., & Drake, C. G. (1990). Surgical treatment of unruptured aneurysms of the posterior circulation. Journal of Neurosurgery, 73(2), 165â173.

Authors 3

Beverly J. Rice (first)
Sydney J. Peerless (additional)
Charles G. Drake (additional)

References 36 Referenced 158

{'key': 'b1', 'series-title': 'No To Shinkei', 'first-page': '693', 'article-title': 'Unruptured cerebral aneurysms: clinical analysis of 80 cases and its new classification.', 'volume': '38', 'author': 'Asari', 'year': '1986'} / No To Shinkei / Unruptured cerebral aneurysms: clinical analysis of 80 cases and its new classification. by Asari (1986)
10.1136/jnnp.22.3.202 / J Neurol Neurosurg Psychiatry / Ruptured posterior fossa aneurysms and their surgical treatment. by Dimsdale (1959)
10.3171/jns.1961.18.2.0230 / J Neurosurg / Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. by Drake (1961)
10.3171/jns.1968.29.4.0372 / J Neurosurg / Further experience with surgical treatment of aneurysms of the basilar artery. by Drake (1968)
10.3171/jns.1968.29.4.0436 / J Neurosurg / The surgical treatment of aneurysms of the basilar artery. by Drake (1968)
{'key': 'b6', 'series-title': 'Current Controversies in Neurosurgery.', 'first-page': '274', 'article-title': 'The surgical treatment of subarachnoid hemorrhage with multiple aneurysms', 'author': 'Drake', 'year': '1976'} / Current Controversies in Neurosurgery. / The surgical treatment of subarachnoid hemorrhage with multiple aneurysms by Drake (1976)
10.1212/WNL.15.3.231 / Neurology / Posterior fossa aneurysms. by Duvoisin (1965)
{'key': 'b8', 'series-title': 'Neurochirurgie', 'first-page': '462', 'article-title': 'Faut-il opérer les anévrysmes asymptomatiques? A propos de 114 anévrysmes asymptomatiques opérés.', 'volume': '33', 'author': 'Freger', 'year': '1987'} / Neurochirurgie / Faut-il opérer les anévrysmes asymptomatiques? A propos de 114 anévrysmes asymptomatiques opérés. by Freger (1987)
10.1016/S0090-3019(82)80020-7 / Surg Neurol / Transient ischemic attacks caused by unruptured intracranial aneurysm. by Fukuoka (1982)
10.3171/jns.1981.55.4.0524 / J Neurosurg / Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. by Heiskanen (1981)
10.3171/jns.1986.65.4.0451 / J Neurosurg / Risks of surgery for unruptured intracranial aneurysms. by Heiskanen (1986)
10.3171/jns.1970.32.3.0295 / J Neurosurg / Risk of rupture of a second aneurysm in patients with multiple aneurysms. by Heiskanen (1970)
10.1016/0090-3019(87)90225-4 / Surg Neurol / Surgery of incidental intracranial aneurysms. by Heiskanen (1987)
10.1111/j.1600-0404.1963.tb05332.x / Acta Neurol Scand / Saccular aneurysms of the vertebral-basilar arterial system. A report of 28 cases. by Höök (1963)
{'key': 'b15', 'series-title': 'J Neurosurg', 'first-page': '544', 'article-title': 'Aneurysms of the vertebrobasilar system. Further experience with nine cases.', 'volume': '28', 'author': 'Jamieson', 'year': '1967'} / J Neurosurg / Aneurysms of the vertebrobasilar system. Further experience with nine cases. by Jamieson (1967)
10.3171/jns.1964.21.9.0781 / J Neurosurg / Aneurysms of the vertebrobasilar system. Surgical intervention in 19 cases. by Jamieson (1964)
10.1093/neurosurgery/24.CN_suppl_1.176 / Clin Neurosurg / The natural history of intracranial aneurysms: rebleeding rates during the acute and long-term period and implication for surgical management. by Jane (1977)
10.3171/jns.1989.70.4.0556 / J Neurosurg / Regrowth of aneurysm sacs from residual neck following aneurysm clipping. by Lin (1989)
10.3171/jns.1966.25.3.0321 / J Neurosurg / Report of the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study. by Locksley (1966)
10.1016/0090-3019(83)90011-3 / Surg Neurol / Posterior circulation aneurysms. Results of direct operations. by MacFarlane (1983)
10.3171/jns.1970.33.4.0422 / J Neurosurg / The size of intracranial saccular aneurysms. An autopsy study. by McCormick (1970)
{'key': 'b22', 'series-title': 'No Shinkei Geka', 'first-page': '133', 'article-title': 'Results of the surgical treatment of multiple aneurysms — review of 372 cases.', 'volume': '16', 'author': 'Mizoi', 'year': '1988'} / No Shinkei Geka / Results of the surgical treatment of multiple aneurysms — review of 372 cases. by Mizoi (1988)
10.3171/jns.1971.35.6.0728 / J Neurosurg / Treatment of multiple intracranial aneurysms. by Mount (1971)
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{'key': 'b25', 'series-title': 'Cerebral Arterial Spasm.', 'first-page': '496', 'article-title': 'Postoperative cerebral vasospasm without subarachnoid hemorrhage', 'author': 'Peerless', 'year': '1980'} / Cerebral Arterial Spasm. / Postoperative cerebral vasospasm without subarachnoid hemorrhage by Peerless (1980)
{'key': 'b26', 'series-title': 'Operative Neurosurgical Techniques. Indications, Methods, and Results.', 'first-page': '973', 'article-title': 'Surgical techniques of posterior cerebral aneurysms', 'volume': '2', 'author': 'Peerless', 'year': '1988'} / Operative Neurosurgical Techniques. Indications, Methods, and Results. / Surgical techniques of posterior cerebral aneurysms by Peerless (1988)
10.1007/978-3-7091-6984-1_5 / Adv Tech Stand Neurosurg / Acute surgery for ruptured posterior circulation aneurysms. by Peerless (1987)
10.3171/jns.1980.53.1.0020 / J Neurosurg / Surgical treatment of asymptomatic and incidental intracranial aneurysms. by Salazar (1980)
10.3171/jns.1977.46.6.0731 / J Neurosurg / Surgical management of unruptured asymptomatic aneurysms. by Samson (1977)
10.3171/jns.1979.51.5.0615 / J Neurosurg / Microneurosurgery for aneurysms of the basilar artery. by Sugita (1979)
10.1111/j.1600-0404.1971.tb07489.x / Acta Neurol Scand / The natural history of aneurysms of the basilar bifurcation. by Troupp (1971)
10.1016/S0039-6109(16)34648-5 / Surg Clin North Am / The surgical treatment of intracranial vestigial aneurysms. by Uihlein (1955)
10.1056/NEJM198103193041203 / N Engl J Med / The natural history of unruptured intracranial aneurysms. by Wiebers (1981)
10.3171/jns.1976.44.5.0537 / J Neurosurg / Surgical treatment for aneurysms of the upper basilar artery. by Wilson (1976)
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10.1080/01616412.1986.11739736 / Neurol Res / Screening and treatment of unruptured cerebral aneurysms. by Yamamoto (1986)

Dates

Type	When
Created	16 years, 3 months ago (May 13, 2009, 2:18 p.m.)
Deposited	2 years, 5 months ago (March 19, 2023, 9:42 p.m.)
Indexed	1 week, 6 days ago (Aug. 19, 2025, 6:12 a.m.)
Issued	35 years, 1 month ago (Aug. 1, 1990)
Published	35 years, 1 month ago (Aug. 1, 1990)
Published Print	35 years, 1 month ago (Aug. 1, 1990)

Funders 0

None

BibTeX

@article{Rice_1990, title={Surgical treatment of unruptured aneurysms of the posterior circulation}, volume={73}, ISSN={0022-3085}, url={http://dx.doi.org/10.3171/jns.1990.73.2.0165}, DOI={10.3171/jns.1990.73.2.0165}, number={2}, journal={Journal of Neurosurgery}, publisher={Journal of Neurosurgery Publishing Group (JNSPG)}, author={Rice, Beverly J. and Peerless, Sydney J. and Drake, Charles G.}, year={1990}, month=aug, pages={165–173} }

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