Microsurgical Clipping of a Ruptured Basilar Apex Aneurysm: Contending with a Formidable Clinical Scenario

Basilar apex aneurysms (BAAs) are challenging and mortal vascular pathologies. In this operative video, we present the case of a 58-year-old female who was admitted with a severe headache and loss of consciousness. She was diagnosed with a ruptured BAA (Fisher grade 4) and merited microsurgical management after careful consideration of aneurysmal features, available clinical setting resources, and discussion with her family. Anatomical nuances for approaching these lesions stepwise are demonstrated in the attached video. Unfortunately, despite adequate surgical treatment, she developed postoperative complications such as cerebral vasospasm and pneumonia, which led to her death. Overall, this technical report depicts the formidable nature of BAA and prompts the need for optimized protocols during the postoperative stage.