Basilar bifurcation aneurysms

Direct operative management of basilar bifurcation aneurysms is one of the most challenging procedures in the realm of vascular neurosurgery, as these lesions are deeply situated in the interpeduncular region and maintain an intimate relationship with important anatomical structures. Direct clipping of aneurysms generally represents the gold standard of surgical treatment, as it allows exclusion of the aneurysmal sac from the circulation, evacuation of aneurysmal contents for decompression, and preservation of efferent flow. The author describes his experience with 123 operated patients of basilar bifurcation aneurysms from January 1977 till December 1995. In these 123 consecutive surgeries the results were 85% good outcome, 8.1% morbidity, and 6.5% mortality. In the first years of this series the pterional or subtemporal approaches were used, depending on the level of the basilar bifurcation, the exact origin of the sac, its projection and size. From 1987 on all patients were operated by a modified pterional approach described initially by Sano as temporopolar approach.