442 - Microsurgery of Basilar Apex Aneurysms

Abstract

Basilar apex aneurysms have been predominantly treated endovascularly in recent years. The evolution of microsurgical treatment of basilar apex aneurysms since the careers of Charles Drake and Gazi Yaşargil has led us to an era where only increasingly complex basilar apex aneurysms and those that have recurred after endovascular treatment have become the primary candidates for open surgery, with only a select group of highly trained and experienced surgeons being able to tackle this pathology. This chapter starts with a discussion of the clinical experience of large series of microsurgically treated basilar apex aneurysms followed by the considerations for treating these lesions via the open approach rather than through endovascular means. Next, we discuss the microsurgical anatomy of the interpeduncular cistern and the various approaches to this region. Technical nuances with each key step of the operation are also discussed along with some thoughts on complication avoidance. The chapter concludes with a discussion of the future of microsurgery for basilar apex aneurysms. The goal of this chapter is to preserve the microsurgical techniques for the younger generation, to inspire a renaissance, and to encourage the consideration of safe surgical clipping of simple basilar apex aneurysms equally amenable to both open and endovascular techniques under well-trained hands. It is our hope that mastery of these simpler aneurysms will boost confidence and improve outcomes for more complex basilar apex aneurysms not amenable to endovascular therapy.