• Rezai JahromiBehnamBDepartments of1Neurosurgery and., Reza Dashti, Nakao Ota, Dabbagh OhadiMohammad AminMADepartments of1Neurosurgery and., Visish Srinivasan, David Fiorella, Hanna Kaukovalta, Aki Laakso, Christoph Schwartz, Riku Kivisaari, Vladimir Zamotin, Antti Lindgren, Timo Koivisto, João M Silva, Oriela Rustemi, Milla Kelahaara, Babak S Jahromi, Monika Killer-Oberpfalzer, Matthew B Potts, Kusumo Noda, Constantin Hecker, Christoph J Griessenauer, Jussi Numminen, Felix Göhre, Hugo Andrade-Barazante, Ferzat Hijazy, Lars Wessels, KalaniM Yashar SMYS4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.12St. John's Neuroscience Institute, Tulsa, Oklahoma., Peter Vajkoczy, Robert F Spetzler, Juha E Jääskeläinen, Akitsugu Kawashima, Ethan Winkler, Olli Tähtinen, Roberto Latini, Jennifer Meessen, Rokuya Tanikawa, Michael T Lawton, and Mika Niemelä.
• Departments of1Neurosurgery and.
• J. Neurosurg. 2024 Dec 20: 1111-11.

ObjectiveDolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion. The goal of this study was to define the natural history of DVBA by long-term follow-up in an international population of patients with DVBA.MethodsThe authors collected data in 382 patients with DVBAs from 11 centers in Europe, the US, and Japan. The patients were followed until new ischemic or hemorrhagic stroke, symptomatic compression of the brainstem or cranial nerves, decline in modified Rankin Scale score, or death. Treatment excluded patients from further analysis. Demographic and radiological characteristics of patients were collected and a new classification was created based on the radiological characteristics of the DVBA. In total 223 patients were treated conservatively in the first phase of treatment. The data required for natural history calculations were available for 221 patients, with a cumulative follow-up of 622.3 patient-years. Kaplan-Meier and Cox regression analyses were used to assess risk factors with an influence on patient outcomes.ResultsIn total, 21.5% of patients were admitted due to the mass effect, and there were 67 (30%) patient deaths during follow-up, 45 (20.2%) of which were related to aneurysms. The annual mortality and morbidity were 10.8% and 1.6%, respectively. Most of the patients with DVBAs were male, although sex did not affect prognosis when compared to the radiological characteristics of the lesion. The natural history of DVBAs was also impacted by a new classification, in which an age 50 years and older predicted mortality. Furthermore, a DVBA's maximum diameter was directly proportional to adverse events.ConclusionsThis study verifies the malignancy of DVBAs and encourages invasive treatment in the early phase of disease progression based on radiological characteristics and patient age when a treatment option is considered suitable. This also stresses the need for continued investigations to develop new therapeutics with acceptable safety profiles.

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