Small Aneurysms at the Bifurcation of the Basilar Artery 493 Patients

Should we still consider clips for basilar apex aneurysms? A critical appraisal of the literature

“…Basilar apex aneurysms constitute 5–8% of all intracranial aneurysms and about 50% of all posterior circulation aneurysms. [ 4 14 25 72 74 ] As posterior circulation aneurysms rupture more frequently with poorer outcomes compared to anterior circulation aneurysms, elective occlusion of unruptured basilar apex aneurysms is recommended. [ 26 27 56 59 71 72 ] Here, a “conservative” approach utilizing serial imaging and waiting for aneurysm growth while exposing the patient to the risk of subarachnoid hemorrhage is inadvisable.…”

“…The first successful basilar apex aneurysm obliteration was performed in 1954 using a subtemporal approach by Herbert Olivecrona and his pupil Einar Bohm in Stockholm. [ 14 ] Subsequently, Dr. Charles Drake in 1959 ligated a high basilar trunk aneurysm using the subtemporal approach. [ 14 15 ] Between 1959 and 1992, Dr. Drake clipped nearly 900 basilar apex aneurysms, including 137 giant basilar aneurysms.…”

“…[ 14 ] Subsequently, Dr. Charles Drake in 1959 ligated a high basilar trunk aneurysm using the subtemporal approach. [ 14 15 ] Between 1959 and 1992, Dr. Drake clipped nearly 900 basilar apex aneurysms, including 137 giant basilar aneurysms. [ 14 ] He achieved excellent/good clinical outcomes in 90% of small (<12.5 mm) and 84% of large basilar apex aneurysms (12.5–25 mm).…”

“…[ 14 15 ] Between 1959 and 1992, Dr. Drake clipped nearly 900 basilar apex aneurysms, including 137 giant basilar aneurysms. [ 14 ] He achieved excellent/good clinical outcomes in 90% of small (<12.5 mm) and 84% of large basilar apex aneurysms (12.5–25 mm). [ 14 ] Although the subtemporal approach offers the shortest and most direct trajectory to the basilar apex, Dr. Drake's experience demonstrated a risk of retraction injury to the temporal lobe and difficulty with visualization of the contralateral first segment of posterior cerebral artery (P1).…”

“…[ 14 ] He achieved excellent/good clinical outcomes in 90% of small (<12.5 mm) and 84% of large basilar apex aneurysms (12.5–25 mm). [ 14 ] Although the subtemporal approach offers the shortest and most direct trajectory to the basilar apex, Dr. Drake's experience demonstrated a risk of retraction injury to the temporal lobe and difficulty with visualization of the contralateral first segment of posterior cerebral artery (P1). Early surgery is recommended to achieve better clinical outcome in ruptured basilar apex aneurysm, especially in good grade cases.…”