Introduction: Most basilar apex aneurysms are nowadays treated with endovascular therapy because microsurgical treatment is more morbid. This trend leads up to 40% recanalization rate with up to 10% intraprocedural complication and up to 2% annual rupture rate. We present our experience with the microsurgical treatment of unruptured predominantly complex basilar apex aneurysms.
Methods: Data on 53 patients with complex basilar apex aneurysms were prospectively collected and retrospectively analyzed. They were treated with transcavernous microsurgical clipping approach. 79% were complex in shape. 70% have a wide neck or posterior projection and 20% were very large or giant (>13 mm).
Results: 39 were female and 14 male. Median age = 57.5 years. Clipping was possible in 96% with a surgical mortality = 0%. The median hospital stay = 5 days. MRS = 0-1 in 85% at discharge and 92% at six months. Only one patient with multiple aneurysms developed regrowth of the base of the aneurysm and was successfully clipped. All patients developed a transient third nerve palsy which recovered in 100% by one year.
Conclusions: Microsurgical treatment of predominantly complex basilar aneurysms is safe and has several advantages over endovascular therapy. There should be more neurosurgeons trained in order to provide patients with a potentially superior treatment option.
Patient Care: By pointing a treatment modality that is superior to the most common treatment nowadays.
Learning Objectives: Learning Objectives
By the conclusion of this session, participants should be able to
1) learn complexity of basilar apex aneurysms.
2) learn the benefits of different treatments of unryptured basilar apex aneurysm.
3) understand the challenge and safe option of clipping of unruptured basilar apex aneurysm.
References: 1.Chalouhi N, Jabbour P, Gonzalez LF, Dumont AS, Rosenwasser R, Starke RM, Gordon D, Hann S, Tjoumakaris S: Safety and Efficacy of Endovascular Treatment of Basilar Tip Aneurysms by Coiling With and Without Stent Assistance: A Review of 235 Cases. Neurosurgery 71 2012.
2. Krisht AF, Kadri PA: Surgical clipping of complex basilar apex aneurysms: a strategy for successful outcome using the pretemporal transzygomatic transcavernous approach. Neurosurgery 56:261-273, 2005