Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients

Neurosurgery. 2013 Feb;72(2):284-98; discussion 298-9. doi: 10.1227/NEU.0b013e3182797952.


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.

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / surgery*
  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Radiography
  • Retrospective Studies
  • Severity of Illness Index
  • Tomography Scanners, X-Ray Computed
  • Treatment Outcome