Ultra-early Surgery of Multiple Aneurysms Including High Position Basilar Bifurcation Aneurysm

It is a standard principle that the ruptured aneurysm must be treated first, then if possible all other aneurysms should be treated in multiple aneurysm case. The same principle is to be applied in cases of a ruptured basilar aneurysm with additional multiple aneurysms. An ultra-early stage operation for multiple aneurysms including a high position basilar bifurcation aneurysm was reported. A 58-year-old female was admitted with clouding of consciousness. CT scan revealed severe and wide subarachnoid hemorrhage mainly around the midbrain. Carotid angiography revealed bilateral middle cerebral artery aneurysms. The left vertebral angiography demonstrated a basilar bifurcation aneurysm with high position 18mm distant from the dorsum sellae. A basilar aneurysm was 10mm in diameter, bigger than two other aneurysms. The ruptured aneurysm was thought to be a basilar aneurysm because of it's size and the location of the subarachnoid clot. The operation was performed 23 hours after the onset using a right fronto-temporal craniotomy. At first the basilar aneurysm was clipped using a subtemporal approach, and then the right middle cerebral artery aneurysm was clipped. Postoperatively cisternal irrigation therapy with ascorbic acid was performed to prevent vasospasm. Symptomatic vasospasm was not observed. Thirteen days after the first operation the left middle cerebral artery aneurysm was clipped. Postoperative course was uneventful without right oculomotor palsy. Ultra-early surgery for basilar bifurcation aneurysms and the approach to its lesion are discussed in this paper.