Treatment of Ruptured Cerebral Aneurysms in the Posterior Circulation

We have experienced 21 cases with ruptured cerebral aneurysms in the posterior circulation during the last 10 years. Nine were male and twelve were female patients. Mean age was 52. We classified these cases into three groups: 1) Basilar artery aneurysms (BA), 2) Aneurysms at the junction of the vertebral and posterior inferior cerebellar arteries (PICA), and 3) fusiform aneurysm of the vertebral artery (VA). Eleven cases were included in the BA group. Nine had aneurysms at the basilar artery summit and two at the junction of the superior cerebellar artery. We performed aneurysm clipping in five cases. Surgery had been done between 8 days through 45 days (mean 22 days) after the SAH attacks. There were two cases with excellent results, two with good results and one with fair. Five out of six non-surgical cases died; three due to severe SAH attack, one due to re-bleeding and one due to respiratory complication. The PICA group comprised eight cases, half of whom had experienced clipping surgery. One case had undergone exceptional surgery on Day 1; while the other three had surgery on Day 8, 13, and 16 respectively. Two had excellent results, one fair and one died (operative failure). All four non-surgical cases died, two due to severe SAH, one due to vasospasm and one due to rebleeding.There were two VA cases. Both had been treated by ligation of the origin of the vertebral artery. Follow-up results were good. As a rule, we have treated patients with ruptured cerebral aneurysms in the posterior circulation by so-called delayed operation. The surgical results have been good in two thirds of the cases, and the mortality rate was 11%. Two patients died of rebleeding while waiting for radical surgery. We conclude that early surgery could be considered, especially in good grade cases, to avoid re-bleeding. Development of microsurgical techniques, intraoperative monitoring systems and brain-protective drugs, etc., would make early surgery possible in cases with ruptured aneurysms in the posterior circulation.