Abstract

Purpose: the purpose of this study is to report mid- and long-term clinical and angiographic results of coiling of basilar tip aneurysms.

Materials and Methods: Between January 1995 and August 2006, 154 basilar tip aneurysms were coiled. One hundred and fourteen (74%) had ruptured and 40 (26%) were unruptured. There were 42 men and 112 women with a mean age of 50.5 years (median 50, range 25-73 years). Mean aneurysm size was 11.1 mm (median 10, range 2-30 mm) and 71 (46%) were large or giant. Of 154 aneurysms, 40 (26%) were primarily coiled with a supporting device.

Results: Initial occlusion was (near) complete in 144 (94%) and incomplete in 10 aneurysms (6%). Combined procedural mortality and morbidity was 3.8% (6 of 154, 95% CI 1.4-8.3%). Mean clinical follow up of 144 surviving patients was 53 months (range 3-144 months, 637 patient years). Annual incidence rate for recurrent hemorrhage was 0.3 % (2 in 637 patient years, 95% CI 0.04-1.1%). During angiographic follow up of mean 34 months (range 6-122 months) in 138 patients (96%), 27 basilar tip aneurysms (17.5%) reopened over time and were additionally coiled. Of these, 11 repeatedly reopened and were repeatedly coiled. Aneurysm size > median 10 mm was the only significant predictor for retreatment at follow up (Odds Ratio 7.0, 95% CI 2.5-19.7).

Conclusion: Coiling of basilar tip aneurysms is safe and effective in preventing recurrent hemorrhage. Follow up angiography is mandatory to timely detect reopening, especially in large and giant aneurysms.