Transpetrosal Combined Supratentorial and Infratentorial Approach for Midline Vertebro-Basilar Aneurysms

Abstract

Difficulties are often encountered in the surgical approach to vertebrobasilar aneurysms situated in the midline at the level of the middle third of the clivus. The subtemporal transtentorial approach reported by Drake (2) gives inadequate room for manipulation of the lower side of the aneurysm neck, particularly when the aneurysm is large in size and fills the depths of the narrow operative field. A conventional lateral suboccipital approach has a similar limitation for the upper side of the aneurysm neck. The transoral clivai approach has the serious drawback of a high risk of postoperative infection.