Abstract
Basilar artery aneurysms are among the most difficult aneurysms to treat microsurgically, and endovascular treatments have replaced microsurgery in many centers. Despite increasing efficacy and safety of endovascular treatments, patients with complex aneurysms, wide-necked, thrombosed, large, or giant aneurysms with vessels arising directly from the aneurysm, are prone to treatment failure with residual aneurysm or aneurysm recurrence. In experienced hands, microsurgery offers a durable cure for appropriately selected patients. In this chapter, we describe our approach to aneurysms of the basilar artery, an illustrative case, and a review of the literature for microsurgery and basilar artery aneurysms.