Surgical Strategy for the Posterior Circulation Aneurysms

In recent years, treatments for the posterior circulation aneurysms have shifted to endovascular treatment. However, there are cases requiring surgical procedures in which endovascular treatment is not applicable. We encountered 10 surgically treated patients with the posterior circulation aneurysms, including 6 subarachnoid hemorrhage cases, in the past 7 years. In 3 cases of posterior cerebral artery (PCA) aneurysms, we mainly used the transmastoid approach, bypass and trapping technique. For 5 patients with vertebro-basilar (V-B) aneurysms, skull base approach and/or bypass technique were required. In 2 cases of posterior inferior cerebellar artery (PICA) dissecting aneurysms, occipital artery (OA)-PICA bypass with trapping of PICA was performed. The outcomes of these 10 patients were evaluated using Glasgow Outcome Scale. Six patients achieved good recovery, 3 patients remained severely disabled, and 1 patient was in a persistent vegetative state. In performing surgery in this field, skull base approaches and bypass technique are crucial, and we have to make effort to train ourselves.