Surgical treatment of basilar top aneurysms

Abstract

Surgical treatment of basilar top aneurysms is still challenging to the neurosurgeons specializing in the treatment of cerebrovascular disease. During the past 18 years, the senior author (DH Han) operated on 79 posterior circulation aneurysms. The number of the basilar bifurcation aneurysms (BBAA) was 38 (49%) in 37 patients, 56% (20 patients) of whom showing multiple aneurysms. Modified pterional approach was the choice of treatment for most of these aneurysms (37 patients), and only 1 patient underwent subtemporal approach. Through the modified pterional approach, senior author achieved aneurysmal neck clipping in 34 aneurysms, and wrapping in the other 4. The overall operative mortality and morbidity were 9% and 31% each, and in patients with good preoperative Hunt–Hess grade (I–II), good results were achieved in 75%, which was comparable to the other series. Transient third nerve palsy was the most frequent postoperative complication that lasted for 2.6 months on average. The surgical tactics of the modified pterional approach used by the author are described with the analysis of the clinical characteristics of his series.