Microsurgery for basilar apex aneurysms: a case series

Although endovascular management has been increasingly adopted for basilar apex aneurysms (BAAs), microsurgery still represents an amenable treatment option. In this case series, six female patients (median age: 46 years) with six saccular high-riding BAAs (50% ruptured) were included. The median neck size was 5.3 mm (range: 2.9-7.9), and the median length from base to dome was 7.25 mm (range: 5.2-11.4). Preoperative complications included hydrocephalus (22%) and rebleeding (22%). All patients underwent clipping with a pterional craniotomy with extension into the temporal bone base. Intraoperative aneurysm rupture occurred in one patient (17%). Postoperative complications occurred in two patients (34%), of which one died because of extensive cerebral vasospasm and hospital-acquired pneumonia. At the 6-month follow-up, all remaining patients had modified Rankin scale scores ≤ 2. Microsurgery remains a viable option for BAAs in limited-resource settings. Technical success depends on delicate tissue work, in-depth anatomical knowledge, and maneuverability in narrow corridors.