Experience with anterior petrosal approach for aneurysms of mid-basilar artery

Background: Anterior petrosal approach (Kawase's approach) is an established technique for the management of basilar artery aneurysms arising near the origin of anterior inferior cerebellar artery (Ba-AICA), however the extent of petrosectomy may vary from patient to patient. Authors report their experience with Kawase's approach for the management of these aneurysms in 5 patients. Methods: During the last 10 years, anterior petrosal approach was used to clip aneurysms of Ba-AICA junction in five patients, who were not suitable for endovascular therapy. Both ruptured and unruptured aneurysms were included in this series. Results: Successful clipping could be achieved in all but one patient. In this patient with a large aneurysm and complex morphology, residual filling was noted in the postoperative angiogram. Postoperatively one patient developed hemiparesis and transient sixth nerve palsy. There was no operative mortality in this series. Conclusion: For patients with small Ba-AICA shoulder aneurysms, where clipping is preferred method of treatment, sufficient exposure is achieved through Kawase approach, however minor variation may be required while resecting the petrous bone.