BACKGROUND Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction (BTVBJ-GFDA) are extremely difficult to treat. OBJECTIVE To evaluate factors influencing survival and outcome of BTVBJ-GFDA by performing a retrospective multicenter cohort study. METHODS A total of 32 patients with BTVBJ-GFDA were included in this study. Clinicopathological characteristics, treatment measures, and outcomes were collected from medical records and imaging studies. Autopsy and histological findings of the aneurysm and adjacent brain tissue were also obtained in 9 cases. RESULTS A total of 11 patients did not undergo surgery, of whom 10 died; 3 from progressive brainstem compression, 4 from subarachnoid hemorrhage, 2 from brainstem infarction, and 1 from associated atherosclerotic disease. The remaining 21 patients underwent a surgical treatment, consisting of immediately proximal parent artery occlusion, remotely proximal parent artery occlusion, clip reconstruction, and distal bypass and achieved significantly longer overall survival compared with those who received conservative therapy (adjusted hazard ratio 1.508, 95% CI 1.058-2.148, P = .02). Histological examination of the aneurysms demonstrated staged clots, open lumen, and intrathrombotic channels with endothelial lining. The patients younger than 45 yr of age showed statistically longer survival than those equal and older than 45 yr (P = .03). CONCLUSION Surgical intervention achieved greater survival than conservative management in BTVBJ-GFDA. Narrow ideal treatment window of the blood flow within the aneurysm to maintain sufficient but not excess supply should be targeted based on the hemodynamics of both the posterior communicating arteries and perforating vessel collaterals.

中文翻译：

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基底干和椎基底动脉交界处的巨大梭形和细长动脉瘤——临床病理和手术结果

背景 基底干和椎基底动脉交界处的巨大梭形和长条状动脉瘤 (BTVBJ-GFDA) 极难治疗。目的通过一项回顾性多中心队列研究来评估影响 BTVBJ-GFDA 生存和结果的因素。方法 本研究共纳入 32 例 BTVBJ-GFDA 患者。从医疗记录和影像学研究中收集临床病理特征、治疗措施和结果。9例还获得了动脉瘤和邻近脑组织的尸检和组织学结果。结果 未行手术共11例，死亡10例；3 例来自进行性脑干压迫，4 例来自蛛网膜下腔出血，2 例来自脑干梗塞，1 例来自相关动脉粥样硬化疾病。其余 21 名患者接受了手术治疗，包括直接近端载瘤动脉闭塞、远近载瘤动脉闭塞、夹子重建和远端旁路手术，与接受保守治疗的患者相比，总生存期显着延长（调整后的风险比 1.508，95% CI 1.058-2.148，P = .02）。动脉瘤的组织学检查显示分期凝块、开放的管腔和带有内皮衬里的血栓内通道。年龄小于 45 岁的患者比 45 岁和年龄大于 45 岁的患者显示出统计学上更长的生存期 (P = .03)。结论 在 BTVBJ-GFDA 中，手术干预比保守治疗获得了更高的生存率。