ANEURYSMS OF THE VERTEBROBASILAR JUNCTION AREA - PRELIMINARY EXPERIENCE IN ENDOVASCULAR AND SURGICAL-MANAGEMENT

Aneurysms of the vertebro-basilar junction area have been considered t he most difficult to be surgically treated because of their deep locat ion, the proximity of the brain stem and the cranial nerves. However, at present, new endovascular techniques and new trans basal surgical a pproaches offer valuable management strategies. This paper concerns si x consecutive patients whom we managed either endovascularly or surgic ally during a period of eighteen months. Direct surgical treatment was offered to two young patients with relatively small aneurysms in good neurological condition, whereas the other four patients initially und erwent an endovascular attempt at aneurysm obliteration using the Gugl ielmi detachable coil system. Unfortunately, interventional neuroradio logy failed in three cases, and surgery had to be re-considered. Accor dingly, a total of five patients underwent surgical clipping through t he combination of a transmastoid retrolabyrinthine approach with the s uboccipital lateral approach. This combination of approaches provided a good control of both vertebral arteries and basilar artery, and allo wed the aneurysm to be correctly clipped in all cases. Good long-term results were achieved in all cases but one. Based on this preliminary experience, we would stress the importance of a multidisciplinary appr oach with a treatment calibrated for each single case. Furthermore, if surgery is to be per formed, the combination of transmastoid-retrolab yrinthine and suboccipital lateral approaches provides a wide exposure of the whole vertebro-basilar junction area and allows good access to the lesion.