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Acta Neurochirurgica

, Volume 160, Issue 6, pp 1149–1153 | Cite as

How I do it: surgical clipping of vertebrobasilar junction aneurysms through a far-lateral transcondylar approach

  • Vladimir Nakov
  • Toma Spiriev
  • Evgeni Stavrev
How I Do it - Vascular
  • 162 Downloads

Abstract

Background

Vertebrobasilar junction aneurysms occur rarely, but have a higher rupture rate than supratentoral aneurysms, and higher morbidity and mortality. Their location ventral to the neuroaxis makes them a challenging surgical lesion.

Methods

In this paper, we share our experience with the surgical technique for the management of these complex aneurysms.

Conclusion

An in-depth understanding of the anatomy of these aneurysms, careful preoperative planning, and a meticulous surgical technique, including knowledge of every detail of the procedure—positioning, an advanced skull base technique, and careful aneurysm dissection and clipping—is essential for a successful outcome of the surgery.

Keywords

Brain aneurysm Vertebrobasilar junction aneurysms Skull-base surgery 

Abbreviations

VA

vertebral artery

VBJ

vertebrobasilar junction

BA

basilar artery

CT

computed tomography

DSA

digital subtraction angiography

WFNS grade

World Federation of Neurosurgical Societies grading score

ICG

indocyanine green

CN

cranial nerve

AICA

anterior inferior cerebellar artery

PICA

posterior inferior cerebellar artery

MEP

motor-evoked potentials

SSEP

somatosensory- evoked potentials

BAEP

brainstem auditory-evoked potentials

SAH

subarachnoid hemorrhage

CSF

cerebrospinal fluid

OA

occipital artery

OC

occipital condyle

Notes

Compliance with ethical standards

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

701_2018_3512_MOESM1_ESM.m4v (162.7 mb)
ESM 1 Video. The video represents an illustrative case of vertebrobasilar junction aneurysm, managed successfully through microsurgical clipping using far lateral approach. The positioning, skin incision, as well as relevant surgical anatomy are presented by 3D animation using OsiriX software (Pixmeo, Bernex, Switzerland). The pre- and post-operative radiological data is also included. (M4V 166589 kb)

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery Acibadem City Clinic Tokuda HospitalSofiaBulgaria
  2. 2.Department of Neurosurgery Military Medical AcademySofiaBulgaria

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