Outcome of the Treatment of Basilar Apex Aneurysms Using Advanced Transcavernous Microsurgical Clipping155

We present the outcome of our experience in treating complex basilar apex aneurysms using advanced microsurgical techniques utilizing variations of the transcavernous approach. Data on 155 surgically clipped basilar apex aneurysms were prospectively collected and retrospectively analyzed. Clipability outcome (clinical and radiologic) were analyzed at discharge, 6 months and 1 year.

Results: 131 out of 155 were basilar tip aneurysms. 54 were ruptured, 6 associated with rupture and 71 unruptured. Of the ruptured aneurysms 51% presented Hunt and Hess Grade III or worse, and 57% were large or giant, mortality was 12%, and at mRs 0–1 in 81% at on one year follow-up. The surgical mortality for the unruptured group was 0%, 95% were mRs 0–2 at one year follow-up. Three of the unruptured group died between 6 months and one year (unrelated cancer, PE, pneumonia) Regrowth occurred in three patients (One at 4 years follow-up, one at 6 year follow-up and one at 8 year follow-up.)

Microsurgical clipping of basilar tip aneurysm using advanced microsurgical techniques continues to be a very durable and safe modality when done in the proper set-up by an experienced team. It should continue to be utilized and promoted especially for aneurysms that have a high endovascular recurrence rate.