Abstract
The surgical techniques for treating the vertebral artery aneurysms are discussed. In the territory of the vertebral artery, atherosclerotic fusiform aneurysms and dissecting aneurysms account for approximately 40% of all aneurysms. These aneurysms are not clippable with an aneurysm clip and should be treated by alternative methods, such as proximal clip occlusion, entrapment, or wrapping. Aneurysms located on the midline or very high in the posterior fossa (13 mm or more posterior to the clivus) are difficult to treat and lower cranial nerve palsy should be anticipated postoperatively. When treating such cases, the right-handed surgeon is advised to select a prone position for a left-sided lesion and a lateral position for right -sided lesion, for in assuming these positionings, the surgical view and surgeon's right hand are properly aligned in operative field. For higher lesions of the vertebral artery, a subtemporal transpetrous surgical approach might be best, this approach requiring drilling the petrous bone between the 5th and the 7th cranial nerves.
