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Microsurgical Management of Basilar Artery Apex Aneurysms: A Single Surgeon's Experience from Louisiana State University, Shreveport Anil Nanda, Ashish Sonig, Anirban Deep Banerjee, Vijay Kumar Javalkar World Neurosurgery Volume 82, Issue 1, Pages (July 2014) DOI: /j.wneu Copyright © 2014 Elsevier Inc. Terms and Conditions
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Figure 1 The image shows the complex factor accumulation index, i.e., the number of complex morphologic features that were present in a patient. World Neurosurgery , DOI: ( /j.wneu ) Copyright © 2014 Elsevier Inc. Terms and Conditions
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Figure 2 A 39-year-old patient with history of hypertension and smoking presented with a severe headache and irritability. Four-vessel angiogram (A and B) revealed a trilobed basilar apex aneurysm. A pterional craniotomy with orbito-zygomatic extension was used for surgical exposure. The posterior communicating artery had to be divided to visualize all the lobes. After a difficult dissection, all the lobes of the aneurysm could be occluded completely with long straight clips (C and D). World Neurosurgery , DOI: ( /j.wneu ) Copyright © 2014 Elsevier Inc. Terms and Conditions
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Figure 3 Coronal magnetic resonance imaging (A and B) as well as four-vessel cerebral angiogram (C) depict a giant, thrombosed, posteriorly directed basilar tip aneurysm. The patient underwent a transcavernous approach, and posterior clinoidectomy was performed. Postoperative angiogram (D) shows complete obliteration of aneurysms. World Neurosurgery , DOI: ( /j.wneu ) Copyright © 2014 Elsevier Inc. Terms and Conditions
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Figure 4 A 65-year-old woman presented with poor Hunt and Hess grade (Grade 3). Plain and contrast computed tomography of the head (A) revealed a large basilar apex aneurysm with hydrocephalus. Four-vessel angiogram showed (B) a large basilar apex aneurysm directed superiorly. The patient underwent a pterional craniotomy, half-and-half approach, and the aneurysm was clipped. Postangiogram lateral (C) and oblique (D) views showed complete obliteration of aneurysm. The patient died 10 days later of a ruptured abdominal aortic aneurysm. World Neurosurgery , DOI: ( /j.wneu ) Copyright © 2014 Elsevier Inc. Terms and Conditions
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