SKULL BASE APPROACHES FOR POSTERIOR CIRCULATION ANEURYSMS

With the emergence of skull base surgery, surgical approaches have bee n developed and redefined, providing surgeons with accessible avenues to difficult lesions of the cranial base. Although the majority of les ions to which these techniques have been applied have been for tumors, we find that these skull base approaches can equally provide access t o difficult vascular lesions, especially complex aneurysms of the post erior circulation. In this report, three different skull base approach es were used in four patients for the treatment of posterior circulati on aneurysms. A cranio-orbital-zygomatic approach was used for the acu te stage of a ruptured basilar tip artery aneurysm and for a giant pos terior cerebral artery aneurysm. A petrosal approach was used for a ru ptured basilar trunk aneurysm, and the transcondylar approach was used for a vertebral artery aneurysm. Each approach provides a wide field and excellent exposure of vital structures with minimal brain retracti on. Neck clipping of the aneurysms was successfully achieved in all ca ses. We believe that our skull base approaches facilitate the surgical treatment of posterior circulation aneurysms.