Chapter 50 - Surgical Management of Terminal Basilar and Posterior Cerebral Artery Aneurysms

Abstract

The young history of basilar tip aneurysms is an interesting one. In the early 19th century, the diagnosis of a ruptured basilar tip aneurysm ultimately led to certain mortality. The pioneering work of Drake paved the way for the successful treatment of these treacherous aneurysms. With each passing decade, as microsurgical techniques and methods improved, so did patient outcomes. The presence of a basilar apex (BA) aneurysm no longer carried the ominous prognosis it had borne just a few decades earlier. Another milestone in the late 20th century again revolutionized therapy for basilar terminus aneurysms: the successful use of Guglielmi detachable coils (GDCs) provided a minimally invasive technique for treating aneurysms in this location. No longer was it necessary for neurosurgeons to navigate through eloquent tissue to treat every BA aneurysm. As with any technology, however, there have been limitations with endovascular therapy. Not every BA aneurysm is amenable to endovascular embolization. Therefore preparation to navigate through the treacherous yet eloquent anatomy for these lesions is imperative for every cerebrovascular surgeon.