Surgical approaches to aneurysms of the vertebral and basilar arteries.

This report details the surgical treatment of 44 patients with aneurysms of the vertebral and basilar arteries. Three different surgical approaches were utilized depending on the location of the aneurysm. These were an anterior supratentorial approach, a lateral suboccipital approach, and a combined supratentorial and infratentorial approach along the petrous apex, with section of the lateral sinus and the tentorium. Using these operative exposures, aneurysms located anywhere on the vertebral-basilar arteries may be safely visualized and clipped. In this series, 1 patient died, 4 other patients had significant, long-lasting morbidity as a result of operation, and 32 patients returned to work and a normal life-style. These data support operative intervention under proper conditions and with selection of the correct exposures for the treatment of vertebral-basilar aneurysms.