Surgical Treatment and Outcomes for Basilar Apex Aneurysms
Abstract
Objectives: Basilar apex aneurysms constitute 5-10% of all intracranial aneurysms. Endovascular and surgical methods are used to treat these aneurysms. Surgical treatment is the gold standard for complete occlusion. Different surgical approaches may be applied depending on the morphological structure of the aneurysm.
Materials and Methods: Thirty-eight basilar apex aneurysms were detected in our institution between October 2017 and January 2020. Sixteen of these patients underwent surgical treatment. The demographic characteristics, angiographic properties, surgical method applied, Glasgow coma scores and Modified Rankin scores (mRS) of the patients were recorded.
Results: Five of the patients were male, 11 were female and the average age was 48.3 years (age range: 20-74 years). While insidental was detected in four of the patients, 12 of them applied with subarachnoid hemorrhage (SAH). As a surgical operation, to nine of them Pterional, to two of them Pretemporal and five of them fronto orbitozygomatic (FROZ) approach were applied. The aneurysm was clipped in all of the patients. In one patient, because the dome of the aneurysm could not be completely closed, wrapping was done. Follow-up angiograms showed that complete occlusion was maintained in all of the aneurysms except the one with wrapping. Two of the patients died. In the follow-up for 2-16 months for the remaining 14 patients, the mRS was 0 in five of the patients, one in six of the patients, two in one of the patients and three in two of the patients.
Conclusion: Basilar apex aneurysms are rare. Various complications may be encountered during endovascular and surgical treatment. Surgical treatment is the superior option to ensure occlusion. Different surgical approaches may be chosen depending on the location and morphological structure of the aneurysm
Keywords
Basilar Apex Aneurysm, Complex Aneurysms, Surgical Treatment
Ethical Statement
Adana City Training and Research Hospital Ethics Committee (date: 03. 04. 2020, no: 902)
References
- 1. Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial Collaborative Group: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360:1267-1274.
- 2. Wiebers DO, Whisnant JP, Meissner I, et al. International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103-110.
- 3. Aziz KMA, van Loveren HR, Tew JM Jr, et al. The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery. 1999;44:1225- 1236.
- 4. Valle JN, Pierot L, Bonafe A, et al. Endovascular treatment of intracranial widenecked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results. AJNR Am J Neuroradiol. 2004;25:298-306.
- 5. Nanda A, Sonig A, Banerjee AD, et al. Microsurgical Management of Basilar Artery Apex Aneurysms: A Single Surgeon’s Experience from Louisiana State University, Shreveport World Neurosurg. 2014;82:118-129.
- 6. Drake CG. Further experience with surgical treatment of aneurysm of the basilar artery. J Neurosurg. 1968;29:372-392.
- 7. Yasargil MG, Antic J, Laciga R, et al. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol. 1976;6:83-91.
- 8. Raymond J, Roy D. Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery. 1997;41:1235-1245.
- 9. Henkes H, Fischer S, Mariushi W, et al. Angiographic and clinical results in 316 coiltreated basilar artery bifurcation aneurysms. J Neurosurg. 2005;103:990-999.
- 10. Samson DS, Hodosh RM, Clark WK. Microsurgical evaluation of the pterional approach to aneurysms of the distal basilar circulation. Neurosurgery. 1978;3:135-141.