Far Lateral Approaches for Intracranial Aneurysms

Kim, Han Kyu

Abstract

Surgical approaches to the posterior circulation aneurysms are difficult and still remained as a matter of debate. Many skull base approaches has been developed to overcome the inadequate exposure of these aneurysm by conventional surgical approaches. Far lateral approaches are an extension of suboccipital approach to expose neurovascular structures around the lower clivus. Aneurysms locating at the vertebral arteries, vertebrobasilar junction and lower basilar artery could be exposed by these approach. However, it is not still evident which kind of far lateral approach is most appropriate for the aneurysms of various locations at these vascular territory. Among the 3 kinds of far lateral approaches, such as far lateral, far lateral transcondylar and extreme lateral transcondylar approach, far lateral approach is not recently used frequently. Far lateral transcondylar approach is good far the aneurysm at the origin of posterior inferior cerebellar artery and the extreme lateral transcondylar approach is useful to expose aneurysms around vertebrobasilar junction. For an appropriate selection of surgical approaches, useful surgical guidelines are mandatory. The recent use of "intermeatal line" and "K lines" and others are of many help for the lower basilar and vertebral artery aneurysms. Surgical approach itself needs knowledge and experience for an adequate performance. Once exposed appropriately manipulation of aneurysms at these locations are not very complicated. Microsurgical anatomy of each surgical step is essential for the sucessful management of aneurysms locating at the lower clivus.