Far-Lateral Approach Without Drilling the Occipital Condyle for Vertebral Artery-Posterior Inferior Cerebellar Artery Aneurysms.

Abstract

The far-lateral transcondylar surgical approach is often used to clip vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms. The role of condyle resection during this approach is controversial. To evaluate patient outcomes in patients with VA-PICA aneurysms in whom drilling the occipital condyle was not necessary. Between May 2005 and December 2012, a total of 56 consecutive patients with incidental or ruptured VA-PICA aneurysms underwent surgery with a far-lateral approach without condylar resection. Clinical presentation, surgical reports, presurgery and postsurgery radiological examinations, and clinical follow-up reports were assessed. Anatomic aneurysm location was analyzed through angiography or computed tomography angiography. We compared postsurgical Glasgow Outcome Scale scores, modified Rankin Scale scores, and morbidity in 2 groups: those with aneurysms in the anterior medullary segment and those with aneurysms in the lateral medullary segment. The predominant presentation was subarachnoid hemorrhage in 34 patients (60.7%). Most aneurysms (n = 27 [48.2%]) were located in the lateral medullary segment of the PICA, followed by the anterior medullary segment (n = 25 [44.6%]). Total aneurysm occlusion was achieved in 100% of patients, and bypass techniques were necessary in 3 patients (5.4%). Fifty-two patients (92.8%) had Glasgow Outcome Scale scores of 4 or 5 postsurgery. A far-lateral approach that leaves the occipital condyle intact is adequate for treating most patients with VA-PICA aneurysms.