The purpose of this retrospective study was to report the morphological characteristics and results of surgical and endovascular treatment of basilar artery (BA) trunk saccular
aneurysms. Twenty-two patients with 22 BA trunk saccular
aneurysms underwent surgery including endovascular intervention. In this series, BA trunk
aneurysms showed characteristic features such as so-called lateral
aneurysm (41%), multiple
aneurysms (32%), including two de novo
aneurysms, and various vascular anomalies. Eleven
craniotomies for neck clipping were performed for 11
ruptured aneurysms. However, in one of these cases, we abandoned neck clipping, because of concern for neck tearing, and embolized it later. Five ruptured and five unruptured
aneurysms were successfully treated by endovascular surgery. Another one incompletely embolized
aneurysm had grown to a huge size, and the patient underwent a Hunterian
ligation with a flow reconstruction. The unusually high incidence of various associated vascular anomalies suggests that focal wall weakness must be based on the mechanism of
aneurysm initiation. Most patients presented with
subarachnoid hemorrhage. The pretreatment neurological state was predictive for clinical outcome. And, clinical outcomes in this series were not affected by the choice of treatment. However, considering that three of 11 surgical cases needed subsequent treatment, endovascular surgery should be considered as a first choice.