[High position basilar top aneurysm treated via third ventricle]

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Conventional surgical approaches (Drake's subtemporal, Yasargil's pterional) pose significant risks for basilar top aneurysms, especially with megadolichobasilar anomaly.
• These standard methods require extensive brain, nerve, and vessel retraction, increasing surgical difficulty and hazard.

Observation:

• A 62-year-old female presented with consciousness disturbance and diffuse subarachnoid hemorrhage with a third ventricular clot.
• Angiography revealed a 5x5 mm basilar top aneurysm with megadolichobasilar anomaly, deemed inaccessible via conventional routes due to its superior location.

Findings:

• A successful direct surgical treatment of a ruptured basilar top aneurysm with megadolichobasilar anomaly was achieved via the third ventricle.
• The procedure involved a bifrontal craniotomy, interhemispheric dissection, and trans-lamina terminalis approach to access and clip the aneurysm.

Implications:

• This case demonstrates the feasibility and efficacy of an alternative surgical corridor for managing complex, high-positioned basilar top aneurysms.
• The trans-third ventricular approach offers a viable option, potentially reducing the risks associated with traditional retraction-based methods.