Intentional body clipping of wide-necked basilar artery bifurcation aneurysms

Object. Neck clipping or coil embolizadon cannot always achieve complete ne ck obstruction in wide-necked basilar artery (BA) bifurcation aneurysms. Cl ipping of the aneurysm body, leaving a small aneurysm rest, is one clipping method used for this kind of aneurysm to maintain the patency of the poste rior cerebral arteries and perforating vessels. However, the long-term effi cacy of intentional body clipping has not been well investigated. The autho rs reviewed their experience with intentional body clipping of wide-necked BA bifurcation aneurysms to determine suitable clipping techniques and the long-term efficacy of the procedure. Methods. Complete neck occlusion was abandoned and body clipping intentiona lly performed in 17 patients with BA bifurcation aneurysms; wrapping of the aneurysm rest was made in seven cases. There were 10 ruptured aneurysms (5 8.8%), and the size of the aneurysm was larger than 10 mm in 11 patients (6 4.7%). The width between the clip blades and the base of the aneurysm neck was 1 mm in 11 cases, 2 mm in four, and 3 mm in two. Favorable outcome (Gla sgow Outcome Scale [COS] Score 4 or 5) was obtained in 13 cases (76.5%) and unfavorable outcome (COS Scores 1-3) in four cases (23.5%). Major causes o f unfavorable outcome included injury to perforating arteries and major ves sel occlusion following surgical manipulation, in addition to the primary d amage caused by subarachnoid hemorrhage. Subarachnoid hemorrhage did not oc cur during a mean follow-up period of 7.4 +/- 5.6 years (range 0.7-18.1 yea rs) after treatment. Conclusions. Intentional body clipping of wide-necked BA aneurysms proved t o be effective to prevent subarachnoid hemorrhage, although injury to perfo rating arteries remains problematic. The choice of complete neck clipping o r body clipping should be established early during the microsugical procedu re to reduce the risk of injury to perforating vessels.