Neck clipping of the basilar bifurcation aneurysm was performed in 32 cases during a 5-year period (1988-1992). The size of the aneurysms varied from 3 to 16mm in diameter and the height of the aneurysm neck ranged from 5mm below to 15mm above the posterior clinoid process. Surgical outcome was excellent in 17 cases, good in 13, fair in 1, poor in 1. These cases were analyzed based on the following aspects: I. approach route, II. extradural procedures, III. intradural procedures, IV. selection of clips.
I. The aneurysms were approached through the opticocarotid route in 6 cases, the retrocarotid route in 21 and the subtemporal route in 5. II. As the extradural procedures, the following were effective to provide wider surgical field: 1. zygomatic osteotomy (n=4), 2. optic unroofing (n=3), 3. drilling of the posterior clinoid process (n=3), 4. section of tentorium (n=5). III. As the intradural procedures, the following had the advantage for better visualization of the aneurysm neck: 1. section of the bridging vein from the temporal pole (n=5), 2. separation of the anterior temporal artery (n=2), 3. direct retraction of the posterior cerebral artery (n=7), basilar artery (n=2) and aneurysm (n=3), 4. preservation of perforating arteries with silicone sheet (n=2). 5. temporary clipping of the basilar artery (n=17), 6. section of the posterior communicating artery (n=3), 7. tentative clipping (n=2). IV. Multiple clipping was performed in 2 cases. The following clips were often used: a mini-clip (n=4), a clip with long blades whose length were more than 15mm (n=13), a straight fenestrated clip (n=3).
The above-mentioned techniques are recommended as surgical options to preserve perforators, which is important to obtain for basilar bifurcation aneurysm.
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