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Original research
A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish?
  1. Manuel F Granja1,
  2. Andre Monteiro2,
  3. Guilherme Jose Agnoletto2,
  4. Sara Jamal2,
  5. Eric Sauvageau1,
  6. Amin Aghaebrahim3,
  7. Ricardo Hanel2
  1. 1 Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  2. 2 Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  3. 3 Neurological Institute, Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr Ricardo Hanel, Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida 32227, USA; rhanel{at}


Background and purpose Non-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs.

Methods Major databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed.

Results A total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1–10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0–2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group.

Conclusions In patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study.

  • aneurysm
  • basilar perforators
  • subarachnoid hemorrhage
  • vertebrobasilar
  • negative angiography

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  • Contributors MFG: manuscript design, writing, editing, and statistical analysis. AM: data gathering, editing, and statistical analysis. GJA, SJ, ES, AA: manuscript writing, editing. RH: original idea, manuscript writing, and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer RH is a consultant and scientific advisor for Microvention, Stryker, and Covidien.

  • Competing interests RH is a consultant for Medtronic, Stryker, Codman, and MicroVention. The remaining authors have nothing to disclose.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.