Abstract
Ten cases of vertebrobasilar trunk aneurysms around the vertebrobasilar junction (VBJ) were operated on by two routes of skull base approach: the middle fossa anterior transpetrosal approach (ATP), or the suboccipital transcondylar approach (STC). In aneurysms located higher than the internal auditory canal (IAC) on lateral angiograms, such as in AICA aneurysms, ATP offered excellent results. In aneurysms lower than the IAC, excellent results were obtainable by STC. For aneurysms on the same level as the IAC, the surgical approach was most difficult and its selection depended on the aneurysm direction and size. In aneurysms with posterior projection, preservation of pontine perforators originating from the VBJ was most important, but difficult in unilateral craniotomy for large aneurysms. An intravascular balloon was useful for temporary occlusion of the proximal vertebral arteries. The combination of skull base surgery and the intravascular technique may offer safer access to those aneurysms.
