Comparison of surgical and endovascular treatment of posterior communicating segment aneurysms.

Flores-Sanchez J.D.; Saal G.; Zumaeta J.; Palacios F.; Rodriguez R.; Molina C. · Surgical Neurology International (2020) · DOI: 10.25259/sni_255_2020

Resumen

Background: Posterior communicating segment aneurysms represent about 25% of all intracranial aneurysms and 50% of the internal carotid artery aneurysms. The objective of the study was to evaluate the efficacy of surgical and endovascular treatments in the management of the aneurysms of this localization. Methods: Comparative and retrospective study. Clinical charts of patients with aneurysms of the posterior communicating segment were reviewed during the period from 2010 to 2017 in the Guillermo Almenara Hospital. Hospital stay, complications, mortality, and functional status at 12 months were compared among endovascular and surgical treatment. Results: Two hundred and fifty-six patients were evaluated, 111 (43.36%) were treated with surgery, and 145 (54.64%) with endovascular therapy. Among ruptured aneurysms, functional independence status was reached in 68 (66.7%) and 69 (70.4%) of the patients who were treated with surgery and embolization respectively (OR: 0.84, IC 95%: 0.46-1.53; P = 0.505). Neurological complications were found in 37 (36.3%) and 34 (34.7%) patients treated with surgery and embolization respectively (OR: 1.07, IC 95%: 0.60-1.91; P = 0.912). The mean hospital stay was 19.55 ± 13.85 and 14.06 ± 14.97 days of the patients treated with surgery and embolization respectively. Mortality was 11.8% and 11.2%, with a slight predominance in the surgically treated group (OR: 1.05, IC 95%: 0.44-2.52; P = 0.904). Conclusion: There is no significant difference according to functional status at 12 months, complications, and mortality among both types of treatments in the group of ruptured aneurysms. Patients treated with endovascular therapy had a lower hospital stay with statistical difference.