Illustrative case: Giant basilar artery aneurysm

A giant basilar trunk aneurysm was diagnosed in an elderly woman with progressing neurologic deficits. After trial basilar artery occlusion was well tolerated, surgical exploration was performed. A large vessel (probably the anterior inferior cerebellar artery) emanated from the fundus of the aneurysm; therefore, definitive clipping of the basilar artery proximal to the aneurysm was performed. Although she hemodynamically tolerated this procedure, delayed thrombosis, thromboembolism, and, finally, subarachnoid hemorrhage proved fatal. This case report illustrates many aspects of surgical strategy and technique which remain controversial and unresolved despite major recent technological advances.