Surgical management of unruptured basilar artery bifurcation aneurysms. Technical note

The basilar artery (BA) bifurcation is the most common site for aneurysms arising from the posterior circulation. Their inhospitable location, nested within the narrow confines of the interpeduncular fossa anterior to the brainstem, coupled with the rich network of adjacent critical thalamoperforating arteries irrigating the midbrain and thalamus, pose difficult anatomical obstacles for the surgeon. The age old adage that the only cure for intracranial aneurysms remains exclusion from circulation before rupture still holds true. Although management of unruptured aneurysms in general is still controversial, unruptured aneurysms of the BA bifurcation can be treated surgically with acceptable rates of morbidity. The clinician must gather and weigh all clinical, pathological, and radiological data when formulating recommendations for the individual patient. In the present report the authors describe their current technique for the surgical management of unruptured BA bifurcation aneurysms; this represents the culmination of the senior author's (N.K.) experience in the management of both ruptured and unruptured BA bifurcation aneurysms. A modified, right-sided subtemporal transtentorial approach has been adopted in all cases of isolated unruptured BA bifurcation aneurysms. Technical nuances are described.