Aneurysms of Vertebro-basilar Junction: a single center experience and meta-analysis of endovascular treatments

Abstract

Vascular lesions of the vertebrobasilar junction (VBJ) are a challenging task in neurosurgical practice, and their gold-standard therapy is still under debate. The authors describe the operative strategies currently in use for the management of those complex vascular lesions and discuss their rationale throughout a literature metaanalysis and a single center blinded retrospective study. The single center study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated with endosaccular coils embolization; whereas a strategy including flow-diverter devices combined with endosaccular coils embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most of the cases. Our Medline review showed that the endovascular treatment was chosen in most of the VBJ cases, whereas the microsurgical option was assigned only to few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent assisted coiling and flow diversion. Our study highlights that aneurysm's morphology, location and patient-specific angioarchitecture are key factors to be considered in the management of VBJ aneurysms. Noteworthy, thus the majority of case series, including ours, shows that parent artery reconstruction using flow-diverter is a feasible and successful technique, in some cases of giant and complex aneurysms (especially those involving the lower 1/3 of the basilar artery) a "seat back, wait and see" approach may represents the safest and most reasonable option.