Surgical Deconstruction of Recurrent Basilar Apex Aneurysms Refractory to Endovascular Treatment

Treating aneurysms of the basilar apex that have recurred despite endovascular treatment presents a difficult clinical situation. Retreatment by endovascular means carries a high risk of requiring complicated endovascular constructs, incomplete results and recurrence, and worsening symptoms of mass effect, whereas surgical disconnection presents an opportunity for a safe, immediate, and durable resolution. We present two cases of microsurgical interruption of the basilar artery immediately below the apex as a treatment for these refractory aneurysms. The angiographic presence of a posterior communicating artery and the intraoperative identification of the perforator-free zone are described, highlighting this intervention as a safe and durable treatment strategy for recurrent aneurysms of the basilar apex.