Dolichoectatic aneurysms of the vertebrobasilar system: Clinical and radiographic factors that predict poor outcomes

David S. Xu, Michael R. Levitt, M. Yashar S. Kalani, Leonardo Rangel-Castilla, Celene B. Mulholland, Isaac J. Abecassis, Ryan P. Morton, John D. Nerva, Adnan H. Siddiqui, Elad I. Levy, Robert F. Spetzler, Felipe C. Albuquerque, Cameron McDougall

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)560-566
Number of pages7
JournalJournal of Neurosurgery
Volume128
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

Keywords

  • Basilar artery
  • Dolichoectasia
  • Fusiform aneurysm
  • Intracranial aneurysm
  • Stroke
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Xu, D. S., Levitt, M. R., Kalani, M. Y. S., Rangel-Castilla, L., Mulholland, C. B., Abecassis, I. J., Morton, R. P., Nerva, J. D., Siddiqui, A. H., Levy, E. I., Spetzler, R. F., Albuquerque, F. C., & McDougall, C. (2018). Dolichoectatic aneurysms of the vertebrobasilar system: Clinical and radiographic factors that predict poor outcomes. Journal of Neurosurgery, 128(2), 560-566. https://doi.org/10.3171/2016.10.JNS161041