Treatment of Basilar Artery Aneurysms: Natural Selection and Propagation of Endovascular Techniques

Abstract

Rupture of cerebral aneurysms represents an important cause of significant morbidity and mortality. Based on prospective autopsy and angiography studies, 3.6–6 % of the population harbors cerebral aneurysms (Vlak et al., Lancet Neurol 10:626–636, 2011). The most complex of these aneurysms are aneurysms residing within the posterior circulation representing 15 % of all cerebral aneurysms (Spetzler et al., J Neurosurg 123:609–617, 2015). Treatment of cerebral aneurysms is achieved with either endovascular, microsurgical, or hybrid techniques. Given the challenging corridors harboring basilar artery (BA) aneurysms, most aneurysms within this region are treated with endovascular techniques; however, the debate of microsurgical vs. endovascular techniques continues. Both Rangel-Castilla et al. and Rutledge et al. present a great discussion of this debate championing endovascular and microsurgical techniques, respectively. We present the highlights of the previous chapters as well interjecting our own experiences in management of basilar artery aneurysms.