Microsurgical clipping of basilar apex aneurysms: A systematic historical review of approaches and their results.

Microsurgical clipping of basilar apex aneurysms: A systematic historical review of approaches and their results.

World Neurosurg. 2018 Mar 27;:

Authors: Alexander S, Fabio S, Javier F, Serge M

Abstract
OBJECTIVE: Neck clipping remains a valuable treatment option for basilar apex aneurysms, especially in those with complex morphology, such as incorporation of branching vessels or large size, and young patient age. A number of approaches have proven to give effective exposure for various types of lesion morphologies. Our historic literature review from 1976 to the present systematically compares the outcomes and complications of the key surgical approaches in the treatment of basilar apex aneurysms.
METHODS: We searched PubMed for articles with at least 5 patients, data on neurologic outcome, and procedure-associated complications for the following approaches: pterional or orbitozygomatic transsylvian, subtemporal (with or without zygomatic osteotomy), pretemporal (with or without transcavernous extension) and transpetrous. N-weighted averages for clinical outcome, aneurysm occlusion rates, morbidity, mortality, and aneurysm morphology were compared.
RESULTS: Of 35 articles selected, 2041 patients with 722 ruptured aneurysms underwent microsurgery, including 1131 transsylvian, 241 pretemporal, 375 subtemporal, and 17 transpetrous approaches. Comparing these four approaches in n-weighted averages, respectively, we noted good neurologic outcomes (81%, 85%, 81%, 58%), surgical morbidity (14%, 10%, 34%, 53%), surgical mortality (4%, 1%, 0, 1%), and complete occlusion rates (95%, 94%, 86%, 75%).
CONCLUSION: Transsylvian, pretemporal and subtemporal approaches showed favorable neurologic outcomes at similar rates and were applied for aneurysms located between -1mm and +7mm in relation to the posterior clinoid process. The pretemporal approach was preferably applied to large and giant aneurysms with good outcome, the transsylvian approach most frequently used for ruptured aneurysms.

PMID: 29602006 [PubMed - as supplied by publisher]

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