• Aymeric Amelot, Stanislas Smajda, Louis-Marie Terrier, Hocine Redjem, Adrien Simonneau, Olivier Bekaert, Michel Piotin, Guillaume Lot, and Dorian Chauvet.
• Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. Electronic address: aymmed@hotmail.fr.
• World Neurosurg. 2017 Feb 1; 98: 104-112.

BackgroundThe prognosis of unruptured giant basilar artery (BA) aneurysms is very poor. No treatment has shown efficacy in survival. This pilot case-control study examines the overall survival (OS) benefit of combined surgical and endovascular management of giant BA aneurysms.MethodsCombined treatment including posterior fossa craniectomy followed by endovascular treatment was performed in 3 patients with giant BA aneurysms. OS of the 3 patients was compared with a control group of 6 patients (ratio 1:2) treated with the endovascular procedure only.ResultsThe mean survival time was 32.6 months in the craniectomy group (SD 9.01, 95% confidence interval [14.9, 50.3]) and 3.5 months in the control group (SD = 2.08, 95% confidence interval [0.001, 7.6]; Mantel-Cox test P < 0.04). At mean follow-up of 36.5 months (SD 10.2), 2 of 3 patients had a favorable outcome with a Glasgow Outcome Scale score of 5. Univariate analysis determined that women had a statistically higher OS than men (33.7 months vs. 3.058 months for men; log-rank test P = 0.011). A similar outcome was obtained in the presence of a circulating posterior communicating artery (P = 0.03) and in the presence of an endovascular right vertebral artery occlusion (P = 0.022).ConclusionsOur study suggests that preventive posterior fossa craniectomy increases significantly OS of patients with giant BA aneurysms.Copyright © 2016 Elsevier Inc. All rights reserved.

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