PLANNING AND SURGICAL STRATEGIES FOR EARLY MANAGEMENT OF VERTEBRAL ARTERY AND VERTEBROBASILAR JUNCTION ANEURYSMS

Selection of the approach and technique for surgical repair of aneurys m of the vertebrobasilar artery system is mainly based on angiographic features. This report emphasizes that planning the surgical procedure should also include preoperative evaluation of the individual skull b ase configuration, as well as the relationship between aneurysm site a nd surrounding bony structures. These features are evaluated on thin s lice CT scans using bone tissue algorithms and are particularly import ant for adequate exposure of distal vertebral artery (VA) or midline a neurysms, because these cases require drilling of the jugular tubercle . For the use of lateral approaches, the surgeon must be familiar with the extradural and intradural anatomy of the foramen magnum region an d may rely on at least five anatomical landmarks for orientation durin g surgery: 1) the dural entrance of the vertebral artery; 2) the poste rior condylar emissary vein; 3) the medial rim of the distal sigmoid s inus; 4) the hypoglossal canal; 5) the jugular tubercle. To increase t he safety of the procedure, the authors recommend an individualized ta iloring of the surgical approach according to the variable morphologic al situation of each patient.