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Microsurgical Clipping of Basilar Apex Aneurysm

A 42 years old lady presented with sudden onset of a severe headache and loss of consciousness. CT scan brain showed subarachnoid hemorrhage (SAH). Digital subtraction angiogram (DSA) and CT angiogram showed a Basilar apex bilobed aneurysm with its neck at the level of dorsum Sella. Since the patient had presented with SAH, the intervention radiologist was reluctant to load the patient with antiplatelet agents in the preparation of stent-assisted coiling. Also, concerns about the broad neck of aneurysm were present. The patient was taken up for microsurgical clipping of aneurysm.

The surgical approach used was right extended fronto-orbitozygomatic, transsylvian, transclinoidal, anterior transpetrosal approach and clipping of the aneurysm.

The surgery video shows the skull base approach made in preparation of clipping of the aneurysm. The anterior petrosal corridor was finally used for temporary control of basilar artery and clipping of the aneurysm. The patient required aVP shunt for hydrocephalus postop and is doing well.

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