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Background: In deciding a treatment for aneurysm occlusion, surgical clipping had long been the main option. In recent years, the use of endovascular coiling technique has seen a substantial rise, leading to discussions on the topic of “clip versus coil” and debating which technique is more favorable. Objective: To compare microsurgical clipping and endovascular coiling by investigating the ruptured intracranial aneurysm treatment outcomes in a real-world setting, in which the patients included in this study were heterogenous in nature. Materials and Methods: A retrospective study of 331 patients. Of these, 229 patients underwent surgical clipping and 102 had endovascular coiling. The primary outcome was modified Rankin scale (mRS) at one year, and the secondary outcomes were rate of aneurysm recurrence, cerebral vasospasm, and shunt-dependent hydrocephalus. Results: Statistically, the authors found no major difference between these two treatment procedures at one year (mRS 0 to 2). Favorable outcomes were 65.5% and 71.6% in clipping and coiling group, respectively (p=0.057). From subgroup analysis of primary outcome, endovascular coiling achieved better results in patients with poor World Federation of Neurosurgical Societies Grading (WFNS) grade (p=0.017) and posterior circulation aneurysms (p=0.018). Coiling showed promising results in poor grade subarachnoid hemorrhage (SAH) patients with 43.8% favorable outcomes. In secondary outcomes, surgical clipping showed more favorable degree of aneurysm obliteration, but with tendency towards cerebral vasospasm. As for shunt-dependent hydrocephalus, there was no difference between the two groups. Conclusion: Results showed similar clinical outcomes between the two treatment groups. However, endovascular coiling had a tendency to benefit patients with poor clinical grade and posterior circulation aneurysms. The treatment decision should be made with individual patient in mind. [ABSTRACT FROM AUTHOR]

Background: Aneurysms of the lower basilar artery (BA) are rare, accounting for <1% of all intracranial aneurysms. This location has been described as "No man's land" since it poses a potential challenge for microsurgery. Recently, endovascular treatment has become an alternative option; however, there are some disadvantages regarding the obliteration rate, patency of the parent, and perforating arteries., Case Description: We present the case of a 69-year-old female with an incidentally found lower BA aneurysm. The imaging examinations revealed a wide-neck aneurysm size of 8.5 mm arising just distal to the vertebrobasilar junction, with involvement of the left anterior inferior cerebellar artery (AICA). After a discussion with the patient, she opted to undergo the surgical treatment. We described the detailed steps of our surgical techniques in performing a combined transpetrosal-transtentorial approach. First, the occipital artery (OA) was harvested. Then, the posterior transpetrosal (retrolabyrinthine) and a far-lateral suboccipital approach were conducted with tentorial sectioning to expose the aneurysm. After AICA was confirmed to arise from the aneurysm sac, the OAAICA bypass was established to ensure AICA patency, followed by complete aneurysm clipping. The approach provided both the presigmoid and retrosigmoid corridors for bypass and clipping procedures, respectively. The patient tolerated the procedure well. Postoperative imaging examinations showed complete aneurysm obliteration and bypass patency without complications. She was discharged without neurological deficits (modified Rankin Scale 0)., Conclusion: The combined transpetrosal approach is safe and effective for revascularization and clipping procedure for a lower BA aneurysm., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)