The small “surgical aneurysm” at the basilar apex

Abstract

Object Because the risks are reduced, larger basilar apex aneurysms are usually treated endovascularly instead of with surgery. However, small basilar apex aneurysms are more common and an unfavorable shape may prevent definitive endovascular treatment. The goal of this study was to reevaluate the outcome of traditional surgery for small unruptured basilar apex aneurysms as an alternative to the currently more accepted endovascular treatment. Methods The authors reviewed clinical data obtained in 21 patients who underwent surgery between 2000 and 2007 for unruptured basilar apex aneurysms < 7 mm. Results The median age of the 21 patients was 52 years (range 29–74 years). All patients experienced a good outcome. Two patients harbored a small residual aneurysm (> 95% occlusion). Eight patients (38%) suffered a temporary third nerve paresis, which resolved in all cases. Conclusions Surgical clip ligation remains an excellent treatment for small basilar apex aneurysms. The treatment is definitive and in experienced hands is associated with a low risk.