Surgical approaches in the treatment of aneurysm of the upper basilar artery

Objective To explore a better approach to the upper basilar artery aneurysm. Methods The preoperative condition, surgical approaches, and outcome of the upper basilar artery aneurysm were summarized. Results Altogether 6 cases of aneurysm in the posterior circulation artery underwent clipping or packing (3 aneurysms at the apex of the basilar artery, 1 aneurysm at the bifurcation of the basilar-superior cerebellar artery and 2 aneurysms at the bifurcation of the basilar-posterior-cerebral artery). On the preoperative Hess and Hunts scale, 2 cases scaled Grade 1, 3 Grade 2, and 1 Grade 3. The ages ranged from 27 to 61 years. In 2 cases the aneurysm was located at the level of the posterior clinoid, 2 above and the other 2 cases below the posterior clinoid. Five cases were clipped and the other fusionform aneurysm was packed. Five patients completely recovered and 1 died. As regards surgical approaches, Yasargil 's transsylvian approach was used in 1 case, 1 case underwent the subtemporal approach, and 4 cases received the frontal-temporal-orbitozygomatic approach. Conclusion The selection of approaches to aneurysm of the upper basilar artery should be decided according to the size and direction of the aneurysm. The frontal-temporal-orbitozygomatic approach is suitable for all the aneurysms, either above or below the dorsum sella. This approach can provide large room to expose the lesion and minimize the retraction of the brain, and should be considered first.