Available online 11 August 2022

AbstractBackground

Both microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both treatment options in terms of both clinical and radiological outcomes.

Methods

The PRISMA method was used to identify related articles. Data collected from each article and the two treatment approaches were compared in terms of favorable clinical outcome and complete/near complete occlusion rate. Subgroup analysis was done based on the size and the rupture status of BAA.

Results

Fifty-nine (59) and 32 articles reported a measurable clinical and radiological outcome respectively. The weighted average favorable clinical outcome was significantly higher in the endovascular group (86.4% vs 79.6%, P < 0.0001), while the weighted average complete/near complete occlusion rate was significantly higher in the surgical group (92.6% vs 83.8%, P < 0.0001). In the subgroup analysis, the favorable clinical outcome remained significantly higher in the endovascular group for the ruptured, unruptured and giant/large BAA (P < 0.001), but not in the small BAA subgroup (P = 0.26). The occlusion rate remained significantly higher in the surgical group for all subgroups (P < 0.001).

Conclusion

Treatment of BAA remains in a trade-off between favorable clinical outcome and complete or near-complete occlusion depending on the treatment modality selected. Careful selection of cases and judicial discussion between open surgical and endovascular team is warranted for treatment optimization.

Section snippetsAbbreviationsBAA

Basilar Apex Aneurysm

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

HH

Hunt and Hess

ADLs

Activity of Daily Livings

GOS

Glasgow Outcome Scale

GOSE

Glasgow Outcome Scale-Extended

mRS

modified Rankin Scale

Guglielmi Detachable Coils

GDC

Methods

Medical literature was reviewed to compare microsurgical to endovascular treatment of the BAA. Databases consulted in the project included: PubMed, EBSCO, and Scopus. Four queries were used for the search: “basilar apex aneurysm”, “basilar top aneurysm”, “basilar tip aneurysm” and “basilar bifurcation aneurysm”. Filters applied to the search engines included: “Human studies”, “English and Spanish publications”, “critical trials”, “clinical studies at any level”, “comparative studies”,

Results

Six-hundred and seventy-three (673) articles were pulled from the three combined databases. Eighteen (18) additional articles were added for screening after reviewing the references of the database-selected articles. Three-hundred and nineteen articles (319) were selected for the secondary review which entitled the Full-text review. Out of the 319 articles, 60 were selected for the study because either one or both clinical or radiological outcomes were reported in a measurable fashion and after

Discussion

Microsurgical treatment of basilar tip aneurysm, beyond other cerebral aneurysm location remains a challenge due to its proximity to the vital brain structures, associated perforating arteries in the interpeduncular space and narrow surgical corridor which makes clipping or wrapping of such aneurysms a daunting task [2], [12], [13], requiring a careful preoperative analysis to select the appropriate skull base approach (i.e. pterional versus cranio-orbito-zygomatic, middle fossa, subtemporal,

Conclusion

With the advent of endovascular coiling there has been a paradigm shift in the treatment of basilar tip aneurysms with the majority of the patients being treated with endovascular coiling. Our study has demonstrated a better clinical outcome in the endovascularly-treated BAA patients, yet the surgical treatment demonstrated a better occlusion rate. Further studies are needed to evaluate this radiological outcome in the era of using the new endovascular technologies such as stenting and flow

Disclosure of interest

The authors declare that they have no competing interest.

Funding

None.

Acknowledgement

None.

References (68)M. Tjahjad et al.Long-term review of selected basilar-tip aneurysm endovascular techniques in a single institution

Interdisciplinary Neurosurgery

(2017)

M. Tjahjadi et al.Should we still consider clips for basilar apex aneurysms?. A critical appraisal of the literature

Surg Neurol Int

(2018)

M.T. LawtonBasilar apex aneurysms: surgical results and perspectives from an initial experience

Neurosurgery

(2002)

S. Sugiyama et al.Blood flow into basilar tip aneurysms: a predictor for recanalization after coil embolization

Stroke

(2016)

I.J. Abecassis et al.Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis

Oper Neurosurg (Hagerstown). Apr

(2019)

E. Tsianaka et al.Clipping versus coiling in posterior circulation intracranial aneurysms: a meta-analysis

Chin Neurosurg J

(2019)

S.C. Jin et al.Analysis of clinical and radiological outcomes in microsurgical and endovascular treatment of basilar apex aneurysms

J Korean Neurosurg Soc

(2009)

K. Nakabayashi et al.Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms

Interv Neuroradiol

(1997)

L.N. Sekhar et al.Basilar tip aneurysms: a microsurgical and endovascular contemporary series of 100 patients

Neurosurgery

(2013)

S. Tateshima et al.Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils: anatomic and clinical outcomes in 73 patients from a single institution

Neurosurgery

(2000)

X. Zhao et al.Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers

Acta Neurochir (Wien)

(2020)

X. Zhao et al.The anterior incisural width as a preoperative indicator for intradural space evaluation: An anatomical investigation

Surg Neurol Int

(2020)

C.G. McDougall et al.Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils

J Neurosurg. Mar

(1996)

L. Pierot et al.Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases

Neurosurgery

(1996)

D.P. Gruber et al.A comparison between endovascular and surgical management of basilar artery apex aneurysms

J Neurosurg

(1999)

B.N. Bohnstedt et al.Comparison of endovascular and microsurgical management of 208 basilar apex aneurysms

J Neurosurg

(2017)

E.F. Hauck et al.The small “surgical aneurysm” at the basilar apex

J Neurosurg

(2010)

N. Chalouhi et al.Safety and efficacy of endovascular treatment of basilar tip aneurysms by coiling with and without stent assistance: a review of 235 cases

Neurosurgery

(2012)

H. Henkes et al.Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms

J Neurosurg

(2005)

A.S. Pandey et al.Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience

Neurosurgery

(2007)

J.P. Peluso et al.Coiling of basilar tip aneurysms: results in 154 consecutive patients with emphasis on recurrent haemorrhage and re-treatment during mid- and long-term follow-up

J Neurol Neurosurg Psychiatry

(2008)

S.N. Chou et al.Surgical treatment of arterial aneurysms of the vertebrobasilar circulation

J Neurosurg

(1974)

M.G. Yasargil et al.Microsurgical pterional approach to aneurysms of the basilar bifurcation

Surg Neurol

(1976)

K. Sugita et al.Microneurosurgery for aneurysms of the basilar artery

J Neurosurg

(1979)

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