Microsurgery for basilar apex aneurysms: a case series.

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Basilar apex aneurysms (BAAs) pose significant treatment challenges.
• Endovascular techniques are increasingly favored, but microsurgery remains an option.

Observation:

• A case series of six female patients with high-riding BAAs (50% ruptured) was analyzed.
• Patients underwent pterional craniotomy with temporal bone base extension for clipping.
• Preoperative complications included hydrocephalus and rebleeding; intraoperative rupture occurred in one patient.

Findings:

• All six patients with saccular high-riding BAAs were successfully treated with microsurgical clipping.
• Postoperative complications were observed in two patients, with one mortality due to vasospasm and pneumonia.
• At 6-month follow-up, remaining patients achieved modified Rankin Scale scores of ≤2, indicating good functional recovery.

Implications:

• Microsurgical clipping is a feasible and effective treatment for basilar apex aneurysms.
• Technical success relies on meticulous surgical technique, anatomical understanding, and navigating confined surgical spaces.
• This approach offers a valuable alternative in settings where advanced endovascular technology may be limited.