Long-term patient outcomes after microsurgical treatment of Blister-like aneurysms of the basilar artery

Michael A. Mooney, M. Yashar S. Kalani, Peter Nakaji, Felipe C. Albuquerque, Cameron McDougall, Robert F. Spetzler, Joseph M. Zabramski

Research output: Contribution to journalArticle

Abstract

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). CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)387-393
Number of pages7
JournalClinical Neurosurgery
Volume11
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Keywords

  • Aneurysm
  • Basilar artery
  • Blister
  • Clipping
  • Endovascular

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Mooney, M. A., Kalani, M. Y. S., Nakaji, P., Albuquerque, F. C., McDougall, C., Spetzler, R. F., & Zabramski, J. M. (2015). Long-term patient outcomes after microsurgical treatment of Blister-like aneurysms of the basilar artery. Clinical Neurosurgery, 11, 387-393. https://doi.org/10.1227/NEU.0000000000000866