Microsurgical Clipping of Complex Basilar Bifurcation Aneurysms through Different Approachs: Surgical Techniques and Results.

Abstract

To explore the surgical approach, technique and clinical effect of treating basilar bifurcation aneurysms. The clinical data of basilar bifurcation aneurysms treated by neuro-microsurgery are retrospectively analyzed in from September 2013 to September 2018. The aneurysms were treated via subtemporal approach and frontotemporal approach. The results were evaluated according to Glasgow Outcome Scores (GOS) and postoperative imaging results. There were 28 aneurysms located at the bifurcation of basilar artery in 27 patients and 1 case had multi-aneurysms. 8 cases underwent via subtemporal approach and 19 via frontotemporal approach. The operation time was 2.8-4.6 hours, the average time were 3.3 hours. The hospitalization time was 3-6 weeks, the average time was 3.8 weeks. Overall, good outcome (GOS score of 4-5) at 6 months was achieved in 77.8% of the living patients. The posterior thalamic perforator artery infarction occurred in 1 cases, and the ventriculoperitoneal shunting was performed in 2 cases due to communicating hydrocephalus. During the following-up period, 25 patients underwent head CTA examination. The CTA showed that all aneurysms were completely clipped, no aneurysm recurrence was found, the blood flow of the parent artery was unobstructed, and 2 patients were lost to follow-up. 13 patients had oculomotor nerve palsy, and all but 3 of them recovered during following-up. The satisfactory results were achieved by microsurgical clipping for basilar bifurcation aneurysms. According to the location and projection of aneurysms, personalized treatment is chosen. Trans-frontotemporal approach is the most suitable approach for the treatment of upper basilar bifurcation aneurysms, especially under subarachnoid hemorrhage causing brain swelling conditions.