A giant basilar trunk aneurysm wis diagnosed in an elderly woman with progressing neurologic deficits. After trial basilar artery occlusion was well tolerated, surgical exploration was performed. A large vessel (probably the anterior inferior cerebel-lar artery) emanated from the fundus of the aneurysm; therefore, definitive clipping of the basilar artery proximal to the aneurysm was performed. Although she hemodynam-ically tolerated this procedure, delayed thrombosis, thromboembolism, and, finally, sub-arachnoid hemorrhage proved fatal. This case report illustrates many aspects of surgical strategy and technique which remain controversial and unresolved despite major recent technological advances.
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