Vertebral Artery Aneurysms: Far-Lateral Suboccipital Approach for Clipping

Indications

• Ruptured aneurysms of the vertebral artery, vertebrobasilar junction, and proximal posterior inferior cerebellar artery (PICA) that are not favorable for endovascular treatment should be considered for surgery.

• Unruptured aneurysms of the vertebral artery, vertebrobasilar junction, and PICA that are unfavorable for endovascular treatment have a higher 5-year rupture risk compared with anterior circulation aneurysms. Unless the patient has significant medical comorbidities, treatment should be considered.

• In aneurysms deemed appropriate for surgical management, the far-lateral approach provides appropriate access to these lesions that are ventral or ventrolateral to the brainstem and below the midclival region.