Background: The treatment of intracranial aneurysms has evolved over the past several decades and has profited by the ingenuity and expertise of generations of innovative neurosurgeons.
Case description: A 79-year-old man presented with symptoms related to recurrence of his previously ruptured basilar bifurcation aneurysm 35 years after undergoing the first awake hunterian ligation for the same aneurysm performed by Dr. Charles Drake.
Conclusions: This report details the treatment strategies applied in the management of the patient's aneurysm then and now, offering us a glimpse into the evolution of neurosurgical treatment for basilar bifurcation aneurysms in a patient who was able to benefit from neurosurgical innovation twice in his lifetime.
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