title: Microsurgical management of basilar artery apex aneurysms: a single surgeon's experience from Louisiana State University, Shreveport.
abstract: OBJECTIVE
  Basilar artery apex aneurysms continue to generate technical challenges and management controversy. Endovascular intervention is becoming the mainstay in the management of these formidable aneurysms, but it has limitations, especially with large/giant or wide neck basilar apex aneurysms. There is paucity of data in the available literature pertaining to the successful management of large/giant, wide neck, and calcified/thrombosed basilar apex aneurysms. We present our experience with consecutively operated complex basilar apex aneurysms so as to present the role of microneurosurgery as a viable management option for these aneurysms.
  
  
  METHODS
  Ours is a retrospective analysis of case-records for operated cases of basilar artery aneurysms spanning 18 years. Basilar apex aneurysms >10 cm, calcified or thrombosed, neck ≥4 mm posterior direction, and retro/subsellar were considered as complex anatomy aneurysms. Basilar apex aneurysms with favorable anatomy were included in the study as a reference group for statistical analysis. Patient demographics, complex features of aneurysms, clinical grade, and outcomes were analyzed.
  
  
  RESULTS
  A total of 33 (53.2%) patients had complex anatomy: large (>10 mm) in eight (24.2%); giant aneurysms (>25 mm) in seven (21.2%); wide-neck in 22 (66.7%); and calcified/thrombosed morphology in five (15.1%). The mean age was 48.5 years, and 22 (66.67%) were women. All aneurysms were clipped by the use of various skull base approaches. A total of 71.9% of patients harboring complex aneurysm had good outcomes. If only unruptured and good grade complex aneurysms also are considered, then 86.9% (n = 20) patients had good outcomes. Statistically there was no significant difference in the outcomes of complex and noncomplex aneurysm.
  
  
  CONCLUSIONS
  Although concerning, the management of large/giant, wide neck, and calcified/thrombosed aneurysms with microneurosurgery is still a competitive alternative to endovascular therapy. After careful selection of appropriate skull base approaches based on the complexity of the basilar apex aneurysm, microneurosurgery can achieve acceptable results.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sonig
authors.affiliation: Department of Functional & Restorative Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Anirban Deep
authors.initials: AD
authors.lastname: Banerjee
authors.affiliation: Department of Neurology, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Javalkar
mesh_terms: D000328:Adult; D001488:Basilar Artery / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008145:Louisiana; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D059906:Neuroimaging; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D016896:Treatment Outcome
keywords: Basilar artery apex; Microsurgical management; Single surgeon