Rodolfo Maduri1, Daniele Starnoni2, Alda Rocca2, David Bervini3, Daniel Walter Zumofen4,5, Martin Nikolaus Stienen6, Bawarjan Schatlo7, Christian Fung8, Thomas Robert9, Martin A Seule10, Jan-Karl Burkhardt6,11, Nicolai Maldaner6, Michel Rothlisberger4, Kristine A Blackham5, Serge Marbacher12, Donato D'Alonzo12, Luca Remonda13, Paolo Machi14, Jan Gralla15, Philippe Bijlenga16, Guillaume Saliou17, Pierluigi Ballabeni18,19, Marc Levivier2,19, Mahmoud Messerer2,19, Roy Thomas Daniel2,19. 1. Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland. Rodolfo.maduri@gmail.com. 2. Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), 46 rue du Bugnon, 1011, Lausanne, Switzerland. 3. Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland. 4. Department of Neurosurgery, Basel University Hospital, Basel, Switzerland. 5. Diagnostic and Interventional Neuroradiology Section, Department of Radiology, Basel University Hospital, Basel, Switzerland. 6. Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences Center, University of Zurich, Zurich, Switzerland. 7. Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany. 8. Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany. 9. Department of Neurosurgery, Ospedale Civico di Lugano, Lugano, Switzerland. 10. Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. 11. Department of Neurosurgery, Baylor Medical Center & College of Medicine, Houston, TX, USA. 12. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland. 13. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland. 14. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospital (HUG), Geneva, Switzerland. 15. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland. 16. Department of Neurosurgery, Hopitaux Universitaires Genève, Geneva, Switzerland. 17. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland. 18. Lausanne Institute for Clinical Epidemiology and Biostatistics, University Hospital Lausanne (CHUV), Lausanne, Switzerland. 19. University of Lausanne (UniL), Lausanne, Switzerland.
Abstract
BACKGROUND: The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques. OBJECTIVE: To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes. METHODS: This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined. RESULTS: From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year. CONCLUSIONS: In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.
BACKGROUND: The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques. OBJECTIVE: To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes. METHODS: This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined. RESULTS: From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year. CONCLUSIONS: In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.