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

Vascular lesions of the vertebrobasilar junction (VBJ) are a challenging task inneurosurgical practice, and their gold-standard therapy is still under debate. Theauthors describe the operative strategies currently in use for the management of thosecomplex vascular lesions and discuss their rationale throughout a literature metaanalysisand a single center blinded retrospective study. The single center studyincluded 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 coilsembolization was the option of choice in large and giant aneurysms, leading tosatisfactory outcomes in most of the cases. Our Medline review showed that theendovascular treatment was chosen in most of the VBJ cases, whereas themicrosurgical option was assigned only to few cases. Among the endovasculartreatments, the most common techniques used for the treatment of VBJ aneurysmswere: coiling, stent assisted coiling and flow diversion.Our study highlights that aneurysm's morphology, location and patient-specific angioarchitectureare key factors to be considered in the management of VBJ aneurysms.Noteworthy, thus the majority of case series, including ours, shows that parent arteryreconstruction using flow-diverter is a feasible and successful technique, in somecases of giant and complex aneurysms (especially those involving the lower 1/3 of thebasilar artery) a "seat back, wait and see" approach may represents the safest andmost reasonable option.