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

How I Do it - Vascular



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.


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


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.


Brain aneurysm Vertebrobasilar junction aneurysms Skull-base surgery 



vertebral artery


vertebrobasilar junction


basilar artery


computed tomography


digital subtraction angiography

WFNS grade

World Federation of Neurosurgical Societies grading score


indocyanine green


cranial nerve


anterior inferior cerebellar artery


posterior inferior cerebellar artery


motor-evoked potentials


somatosensory- evoked potentials


brainstem auditory-evoked potentials


subarachnoid hemorrhage


cerebrospinal fluid


occipital artery


occipital condyle


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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