Basilar apex aneurysms: surgical results and perspectives from an initial experience.
OBJECTIVE
To demonstrate that well-trained neurosurgeons can successfully treat patients with basilar apex aneurysms, to encourage young neurosurgeons in appropriate clinical environments to develop this expertise, and to describe a personal experience with an initial series.


METHODS
In a consecutive series of 500 aneurysms treated surgically over 3.5 years, 57 aneurysms in 56 patients were located at the basilar apex, 47% of which were large or giant in size.


RESULTS
Most aneurysms (77%) were treated by direct clipping through an orbitozygomatic-pterional transsylvian approach. The surgical mortality rate was 9%, and permanent neurological morbidity associated with treatment occurred in 5%. Good outcomes (Glasgow Outcome Scale score 5 or 4) were achieved in 84%. Good outcomes increased from 79% in the first half of the series to 90% in the second half, and the mortality rate decreased from 21 to 4%.


CONCLUSIONS
Young neurosurgeons can acquire technical proficiency with basilar apex aneurysms while achieving optimal patient outcomes. Young neurosurgeons with the right training, talent, and temperament are needed to deal with those patients with basilar aneurysms who require surgery and with a possible shortage of basilar aneurysm surgeons in the future. The learning curve is characterized by increased temporary clipping, better perforator dissection, and more sophisticated permanent clipping technique. The path to proficiency can be as demanding mentally as it is technically.
Lawton
Michael T
MT
Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, M-780C, San Francisco, CA 94143-0112, USA. lawtonm@neurosurg.ucsf.edu
D000328:Adult; D000368:Aged; D002423:Cause of Death; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000601:surgery; D013525:Surgical Instruments; D015996:Survival Rate