Possibility of the excision of aneurysms in the vertebrobasilar system followed by end-to-end anastomosis for the maintenance of circulation.

Microsurgical techniques have revolutionized the perspectives of neurosurgery. Vascular neurosurgery in particular has only shown real progress since the evolution of such techniques. The management of large fusiform aneurysms had always been more problematic than that of the usual aneurysms. Clipping was either insufficient to occlude the whole neck or too extensive to include a significant part of the parent vessel and its important branches. Several alternative methods were therefore developed to redress the problem and included proximal occlusion, coating and wrapping, induction of intralaminal thrombosis with a variety of substances, and balloon catheter occlusions; however, they have all proved to have limited success. Aneurysmorrhaphy (excision of the aneurysm and reconstruction of the vessel wall) has also been described. In 1978 Dolenc reported excision of a fusiform aneurysm along with the adjacent vessel wall and an end-to-end anastomosis, either directly or by interposing a short arterial graft, in two cases of peripheral middle cerebral aneurysms, and in one aneurysm arising from PICA. This communication deals with two cases of large fusiform aneurysms of the vertebrobasillar territory, one from PICA and another from P2P3 Segment of the posterior cerebral arteries. These aneurysms were excised and the parent vessel reanastomosed to restore its continuity as seen at surgery and on postoperative angiography. The results have been favourable. The technique is recommended for the elimination of a large fusiform aneurysm that cannot be safely or successfully clipped, provided the parent vessel is lax or mobile enough to permit direct reanastomosis despite the slight shortening of vessel length.