Introduction: Blister-like aneurysms (BLAs) are challenging lesions that require unique microsurgical strategies. BLAs are predominantly found along the internal carotid artery, however, BLAs of the basilar artery are a rare subset that require a modified treatment strategy.
Methods: We retrospectively reviewed the surgical technique, postoperative results, and long-term outcomes of all patients with basilar artery BLAs treated at our institution from 2005 to 2011.
Results: Four patients with basilar artery BLAs were identified over this 6 year interval. All four patients were treated by direct microsurgical clipping. A thin layer of cotton-reinforcement was used beneath the clip tines to minimize the risk of clip slippage in 2 of 4 patients; 1 patient required adjunctive endovascular stent placement for residual aneurysm after clipping. Complete obliteration of all aneurysms was achieved and there has been no recurrence at mean clinical follow-up of 72 months (median, 74.5; range, 37-103) and imaging follow-up of 48 months (median, 54; range 12-72).
Conclusions: Direct clipping with or without cotton reinforcement can obliterate basilar BLAs with excellent long-term outcomes. Clip-wrapping is not an option for these lesions given the proximity to perforating branches. Endovascular techniques provide a useful adjunctive strategy, however, risks for antiplatelet therapy in the acute subarachnoid hemorrhage period must be considered.
Patient Care: This series highlights our experience with blister-like aneurysms of the basilar artery. These are rare but dangerous lesions, and they require a unique treatment strategy compared to their counterparts along the internal carotid artery. We have outlined our approach and report excellent long-term outcomes for these lesions with microsurgical clipping as the initial treatment strategy.
Learning Objectives: Examine and improve the management of blister-like aneurysms of the basilar artery.