title: Basilar tip aneurysms:  a microsurgical and endovascular contemporary series of 100 patients.
abstract: BACKGROUND
  Endovascular therapy has largely replaced microsurgical clipping for the treatment of basilar tip aneurysms.
  
  
  OBJECTIVE
  We describe the variables our center evaluates when choosing to clip or coil basilar tip aneurysms and our outcomes. Four case illustrations are presented.
  
  
  METHODS
  All patients with ruptured or unruptured basilar tip aneurysms from 2005 to April 2012 were examined. The patients were treated by 2 interventional neuroradiologists and 2 dually trained neurosurgeons.
  
  
  RESULTS
  There were 63 ruptured (clipped 38%, coiled 62%) and 37 unruptured (clipped 35%, coiled 65%) aneurysms in this 100-patient study. Seventy percent of the patients with ruptured aneurysms and 92% of the patients with unruptured aneurysms had a good outcome (modified Rankin scale 0-2) at 3 months. For ruptured aneurysms, there was a statistically significant difference in clipping and coiling with respect to age and treatment modality (clip 48.8 years, coil 57.6 years). Patients in the coiled group had higher dome-to-neck (1.3 vs 1.1) (P = .01) and aspect ratios (1.6 vs 1.2) (P = .007). In the ruptured coiling group, 69.5% achieved a Raymond 1 radiographic outcome, 28% Raymond 2, and 2.5% Raymond 3. Eleven (17.4%) patients required re-treatment, and 3 (4.4%) patients were re-treated more than twice. Coiling of unruptured aneurysms resulted in 75% Raymond 1. There were no residual lesions for unruptured clipped aneurysms. There were no differences in outcome between clipping and coiling in the ruptured and unruptured group.
  
  
  CONCLUSIONS
  In our current management of basilar tip aneurysms, the majority can be treated via endovascular means, albeit with the expectation of a higher percentage of residual lesions and recurrences. Microsurgery is still appropriate for aneurysms with complex neck morphologies and in young patients desiring a more durable treatment.
authors.affiliation: Department of Neurosurgery, University of Washington, Seattle, Washington, USA. lsekhar@u.washington.edu
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: Farzana
authors.initials: F
authors.lastname: Tariq
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.forename: Basavaraj
authors.initials: B
authors.lastname: Ghodke
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Hallam
authors.forename: Jason
authors.initials: J
authors.lastname: Barber
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome