Ruptured posterior circulation aneurysms: epidemiology, patterns of care, and outcomes from the Swiss SOS national registry

  • Rodolfo MaduriEmail author
  • Daniele Starnoni
  • Alda Rocca
  • David Bervini
  • Daniel Walter Zumofen
  • Martin Nikolaus Stienen
  • Bawarjan Schatlo
  • Christian Fung
  • Thomas Robert
  • Martin A. Seule
  • Jan-Karl Burkhardt
  • Nicolai Maldaner
  • Michel Rothlisberger
  • Kristine A. Blackham
  • Serge Marbacher
  • Donato D’Alonzo
  • Luca Remonda
  • Paolo Machi
  • Jan Gralla
  • Philippe Bijlenga
  • Guillaume Saliou
  • Pierluigi Ballabeni
  • Marc Levivier
  • Mahmoud Messerer
  • Daniel Roy Thomas
  • Swiss SOS Group
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm
  2. Vascular Neurosurgery – Aneurysm



The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.


To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.


This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.


From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.


In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers.


Aneurysmal subarachnoid hemorrhage Posterior circulation Intracranial aneurysms Ruptured aneurysms Endovascular procedures Intracranial vasospasm Hydrocephalus 



The authors thank all past and present collaborators of the Swiss SOS study group for their support. We also than Madame Marion Brun, Department of Otorhinoloaryngology and Head and Neck Surgery, University Hospital of Lausanne (CHUV), for the artist drawing (Fig. 1).


The Department of Clinical Neurosurgery of the Lausanne University Hospital provided financial support in the form of funding for the statistical analysis. The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the local Ethical Committee (Geneva Ethics Committee Board no. 11-233R, NAC 11-085R) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this retrospective type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Rodolfo Maduri
    • 1
    Email author
  • Daniele Starnoni
    • 1
  • Alda Rocca
    • 1
  • David Bervini
    • 2
  • Daniel Walter Zumofen
    • 3
    • 4
  • Martin Nikolaus Stienen
    • 5
  • Bawarjan Schatlo
    • 6
  • Christian Fung
    • 7
  • Thomas Robert
    • 8
  • Martin A. Seule
    • 9
  • Jan-Karl Burkhardt
    • 5
    • 10
  • Nicolai Maldaner
    • 5
  • Michel Rothlisberger
    • 3
  • Kristine A. Blackham
    • 4
  • Serge Marbacher
    • 11
  • Donato D’Alonzo
    • 11
  • Luca Remonda
    • 12
  • Paolo Machi
    • 13
  • Jan Gralla
    • 14
  • Philippe Bijlenga
    • 15
  • Guillaume Saliou
    • 16
  • Pierluigi Ballabeni
    • 17
    • 18
  • Marc Levivier
    • 1
    • 18
  • Mahmoud Messerer
    • 1
    • 18
  • Daniel Roy Thomas
    • 1
    • 18
  • Swiss SOS Group
  1. 1.Department of Clinical Neurosciences, Service of NeurosurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  2. 2.Department of Neurosurgery, InselspitalUniversity of BernBernSwitzerland
  3. 3.Department of NeurosurgeryBasel University HospitalBaselSwitzerland
  4. 4.Diagnostic and Interventional Neuroradiology Section, Department of RadiologyBasel University HospitalBaselSwitzerland
  5. 5.Department of Neurosurgery, University Hospital of Zurich & Clinical Neurosciences CenterUniversity of ZurichZurichSwitzerland
  6. 6.Department of NeurosurgeryUniversity Hospital GöttingenGöttingenGermany
  7. 7.Department of Neurosurgery, Medical CenterUniversity of FreiburgFreiburgGermany
  8. 8.Department of NeurosurgeryOspedale Civico di LuganoLuganoSwitzerland
  9. 9.Department of NeurosurgeryKantonsspital St. GallenSt. GallenSwitzerland
  10. 10.Department of NeurosurgeryBaylor Medical Center & College of MedicineHoustonUSA
  11. 11.Department of NeurosurgeryKantonsspital AarauAarauSwitzerland
  12. 12.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyKantonsspital AarauAarauSwitzerland
  13. 13.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyGeneva University Hospital (HUG)GenevaSwitzerland
  14. 14.Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, InselspitalUniversity of BernBernSwitzerland
  15. 15.Department of NeurosurgeryHopitaux Universitaires GenèveGenevaSwitzerland
  16. 16.Department of Radiology, Division of Diagnostic and Interventional NeuroradiologyLausanne University Hospital (CHUV)LausanneSwitzerland
  17. 17.Lausanne Institute for Clinical Epidemiology and BiostatisticsUniversity Hospital Lausanne (CHUV)LausanneSwitzerland
  18. 18.University of Lausanne (UniL)LausanneSwitzerland

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