INTRODUCTION: A paucity of patients with ruptured basilar apex aneurysms have been analyzed with long-term clinical results. METHODS: Sixty-one consecutive ruptured basilar apex aneurysms from 2005 to 2011 were retrospectively reviewed. A team-oriented approach was used to decide treatment. Clipping was typically used in younger patients, those with a complex neck anatomy, or when the origin of PCA was from the aneurysmal sac. RESULTS: Demograhics and Outcome: Coiling Group (n = 39 or 64%): The average age was 57 with a Hunt and Hess grade (HH) 3.3. At discharge 10% had died, 33% had a poor outcome (mRS3-5) and 57% had a good outcome (mRS0-2). Analyzing survivors, drastic long term improvement was noted. At three months, 78% of these patients were a mRS 0-2 which improved to 87% by one year. Clipping group (n = 22 or 36%): The average age was 49 with a HH grade of 2.6. At discharge 14% had died, 27% had a poor outcome and 59% had a good outcome. Analyzing the survivors, dramatic improvement was seen. At three months, 82% of these patients were a mRS 0-2 which improved to 86% at one year. Eight out of 22 (37%) patients had post-operative 3rd nerve palsies. All but one resolved at longest follow up. Radiographic outcome: After initial coiling, 59% achieved a Raymond 1, 36% Raymond 2, and 2.5% Raymond 3. 11/15 Raymond 2 or 3 patients had long term follow up. In this group, 46% had stable disease that did not require treatment, 27% spontaneously resolved, and 27% required re-treatment. One patient (4.5%) in the Clipping group had a residual stable lesion at one year. CONCLUSION: By using a team-oriented approach, both clipping and coiling of ruptured basilar apex aneurysms provided excellent long term outcomes with >85% of survivors reaching a good outcome by one year. Copyright (C) by the Congress of Neurological Surgeons
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