Management Outcome and Clinical Manifestation of Posterior Circulation Aneurysms VS. Anterior Circulation Aneurysm

Jeong, Je Hoon; Kim, Gook Ki; Koh, Jun Seok; Lim, Young Jin; Kim, Tae Sung; Leem, Won; Rhee, Bong Arm

Abstract

OBJECT: With the recent variable treatment modalities and the development of microsurgical techniques, outcomes of surgical and medical management of aneurysm have shown much progress in the last 10 years. However, the management of posterior circulation aneurysm is still a debatable due to its difficulty in limited surgical approach, complicated anatomical structure and many small perforators to vital structure. The purpose of this study is to compare the results of clinical manifestation and outcome of surgery with respect to anterior and posterior circulation aneurysms. MATERIAL AND METHODS: We evaluated the 33 patients with PCAs(posterior circulation aneurysm) and 359 patients with ACAs(anterior circulation aneurysm) treated between 1994 and 1999, retrospectively.
RESULTS
Posterior circulation aneurysms showed higher tendency(5 cases, 14.7%) to have unusual shapes, such as dissecting or fusiform compared with anterior circulation aneurysm(15 cases, 4.2%). There were more multiple aneurysms in posterior circulation aneurysm(8 cases, 26.5%) than anterior circulation aneurysm(59 cases, 16.2%). The number of patients with Hunt-Hess grade III or IV on admission were 91(25.3%) in anterior circulation aneurysms, and 14(42.4%) in posterior circulation aneurysms. There were higher incidences of vasospasm and acute hydrocephalus in patients with posterior circulation aneurysm. In cases of anterior circulation aneurysm, neck clipping was possible in 97%. But, in posterior circulation aneurysm, neck clipping was possible only in 67.7% of each. Two hundred forty four cases(85.0%) of all anterior circulation aneurysms and 22 cases(78.6%) of all posterior circulation aneurysms showed good recovery(GR) or moderate disability(MD). The postoperative mortality rates of anterior and posterior circulation aneurysms were 4.9% and 10.7%, respectively.
CONCLUSION
These results indicate that there exist substantial differences with respect to that there were few difference in the aspect of surgery and management outcome between posterior circulation aneurysms and anterior circulation aneurysms.