• M Yashar S Kalani, Joseph M Zabramski, Peter Nakaji, and Robert F Spetzler.
• Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
• Neurosurgery. 2014 Sep 1;10 Suppl 3:E493-7; discussion E497.

Background And ImportanceCurrent microsurgical and endovascular therapies have offered little advancement for the treatment of complex vertebrobasilar aneurysms. The outcome of patients with these rare lesions has remained poor, despite sometimes heroic measures.Clinical PresentationThe authors report a case of a 65-year-old man who 20 years earlier had presented with symptoms suggestive of brainstem compression. Imaging at the time revealed a giant, serpentine aneurysm of the basilar artery. The patient was treated with superficial temporal artery to superior cerebellar artery bypass and decompression of the aneurysm contents. Twenty years after this treatment, the patient remains functionally intact with few sequelae from his treatment or the pathology. Follow-up imaging reveals thrombosis of the aneurysm without ischemic damage to the brainstem.ConclusionThis case demonstrates that good functional outcomes are possible for select complex posterior circulation aneurysms by using flow reversal and revascularization; however, at this time, we are unable to predict for which patients this strategy will be successful.

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