Abstract
Background Aneurysms arising from basilar perforator arteries are very rare. A primary goal
of surgery is always preservation of perforator flow. However, in most surgically
managed cases in the literature, sacrifice of the perforator was reported. It is important
for the literature to demonstrate that patency of the perforator is an achievable
goal.
Objective To present the second reported case of perforator flow preservation in the surgical
management of basilar perforator artery aneurysms.
Clinical Presentation A 45-year-old woman presented with World Federation of Neurologic Surgeons grade
1 subarachnoid hemorrhage. Digital subtraction angiography ultimately revealed a 2-mm
aneurysm of the basilar artery arising from a perforator after an initially negative
angiogram. Clipping was performed with perforator patency confirmed on direct inspection
and intraoperative angiography. The patient's postoperative course was uneventful,
and postoperative magnetic resonance imaging (MRI) showed no evidence of brainstem
stroke.
Conclusion Although patency of the perforator is a rather obvious goal of cerebrovascular surgery,
the current literature does not reflect an ability to do so in the case of basilar
perforator aneurysms. We present only the second reported case of maintenance of perforator
flow after clipping of a basilar perforator artery aneurysm.
Keywords
microsurgical clipping - cerebral aneurysm - basilar perforator aneurysm
