An Anterior Approach to Aneurysms of the Vertebro-Basilar Junction

Summary The surgical treatment of anteriorly placed aneurysms of the posterior circulation crries a high morbidity which is mainly due to their inaccessibility. This is partly due to the need to retract the brainstem and cranial nerves. An anterior approach theoretically avoids this and we have used a Le Fort 1 maxillotomy to approach ten of these aneurysms. Nine aneurysms were successfully clipped and one was wrapped. Morbidity was two cases of meningitis and one temporary sixth nerve palsy. There were no deaths and at six month follow up all patients had achieved a good outcome on the Glasgow Outcome Scale. In conclusion this approach can be used with minimum morbidity and offers several advantages over posterior approaches.