Long-term Patient Outcomes After Microsurgical Treatment of Blister-Like Aneurysms of the Basilar Artery.
BACKGROUND
Blister-like aneurysms (BLAs) are challenging lesions that require unique microsurgical strategies. BLAs are predominantly found along the internal carotid artery; however, BLAs of the basilar artery are a rare subset that requires a modified treatment strategy.


OBJECTIVE
To discuss the microsurgical management and review the long-term outcomes of patients with BLAs of the basilar artery.


METHODS
We retrospectively reviewed the surgical technique, postoperative results, and long-term outcomes of all patients with basilar artery BLAs treated at our institution from 2005 to 2011.


RESULTS
Four patients with basilar artery BLAs were identified over this 6-year interval. All 4 patients were treated by direct microsurgical clipping. A thin layer of cotton reinforcement was used beneath the clip tines to minimize the risk of clip slippage in 2 of 4 patients; 1 patient required adjunctive endovascular stent placement for residual aneurysm after clipping. Complete obliteration of all aneurysms was achieved, and there has been no recurrence at mean clinical follow-up of 72 months (median, 74.5; range, 37-103) and imaging follow-up of 48 months (median, 54; range 12-72).


CONCLUSIONS
Direct clipping with or without cotton reinforcement can obliterate basilar BLAs with excellent long-term outcomes. Clip wrapping is not an option for these lesions given the proximity to perforating branches. Endovascular techniques provide a useful adjunctive strategy; however, risks with antiplatelet therapy in the acute subarachnoid hemorrhage period must be considered.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael A
MA
Mooney
M Yashar S
MY
Kalani
Peter
P
Nakaji
Felipe C
FC
Albuquerque
Cameron G
CG
McDougall
Robert F
RF
Spetzler
Joseph M
JM
Zabramski
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000601:surgery; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents; D013525:Surgical Instruments; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors