Basilar apex artery aneurysm clipping: how I do it

Approximately 5-8% of intracranial aneurysms arise from the basilar artery apex (BAA). Given the basilar artery role in supplying the brainstem and the posterior cerebral circulation, the rates of morbidity and mortality are especially high in case of rupture. Although endovascular occlusion techniques are overall favored, thus leading to decreasing surgical expertise, complex BAA aneurysm may still require treatment with microsurgical occlusion. We describe our institutional perioperative protocol in the management of BAA aneurysms, focusing on surgical anatomy, approach selection, and intraoperative nuances.