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Internal Carotid Artery to Posterior Cerebral Artery Bypass for Fusiform Basilar Artery Aneurysm: 2-Dimensional Operative Video.

Fusiform dolichoectatic basilar trunk aneurysms pose an immense surgical challenge because of the extremely eloquent tissue at risk during the procedure and the complex management strategies required to relieve mass effect on the brainstem. The patient presented in this case experienced progressive brainstem deterioration with quadraparesis and multiple cranial neuropathies. The patient underwent a modified orbitozygomatic craniotomy for visualization, and an end-to-side anastomosis between a radial artery interposition graft and the posterior cerebral artery was performed, followed by an end-to-side anastomosis of the interposition graft to the intracranial internal carotid artery. A permanent clip was applied to the top of the basilar trunk to obliterate distal flow. Postoperative imaging demonstrated progressive thrombosis of the fusiform aneurysm. Basilar aneurysms represent challenging lesions for both microsurgical and endovascular treatments. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.