Posterior circulation aneurysms. Technical strategies based on angiographic anatomical findings and the results of 60 recent consecutive cases.

Abstract

Ninety-eight patients with aneurysms of the posterior circulation were admitted to our department from 1993 to 1997. Sixty of them underwent microsurgical treatment, mostly in the acute stage of subarachnoid hemorrhage. Peri- and intraoperative management were carried out according to a structured treatment strategy. Special aspects of surgical technique included extradural selective anterior clinoidectomy for basilar head aneurysms, lateral suboccipital craniotomy and partial condylectomy without laminectomy for aneurysms of the vertebral artery or posterior inferior cerebellar artery, and a trans-Sylvian approach, as used in selective amygdalohippocampectomy, for aneurysms of the posterior cerebral artery. A careful angiographic evaluation of the aneurysms in relation to the neighboring important arteries and bony structures was essential for optimal surgical planning. Forty-nine patients (82%) made a good recovery by 3 months after surgery. The mortality was 7%.