Transcondylar Fossa Approach to Unruptured Vertebral Artery and Vertebral Artery-Posterior Inferior Cerebellar Artery...

Surgical treatment of vertebral artery (VA) and VA-proximal posterior inferior cerebellar artery (PICA) aneurysms poses a special challenge to the operating surgeon because of the complex anatomy of the neck and the location of the aneurysm. We report our surgical results of unruptured VA and VA-PICA aneurysms operated on through the transcondylar fossa approach.

We retrospectively analyzed the data of 20 patients with unruptured VA and VA-PICA aneurysms who were treated by the transcondylar fossa approach in a single institution from November 2014 to March 2018. Data including clinical profile, radiology, complications, and outcome were analyzed.

Five patients had VA aneurysms and 15 had VA-PICA aneurysms. All were unruptured aneurysms, and 4 patients were symptomatic. All underwent surgical treatment through the transcondylar fossa approach. Proximal VA occlusion alone for 4 patients along with revascularization for 3 patients was performed. Twelve patients underwent clipping and 1 underwent wrapping of the aneurysm. The transcondylar fossa approach was adequate to expose the aneurysms successfully. There were no intraoperative complications encountered. Only 3 patients had transient postoperative complications. Follow-up imaging showed complete occlusion of all clipped aneurysms and complete thrombosis of the sac in all patients with proximal VA occlusion with or without revascularization.

Although the incidence of rupture of asymptomatic unruptured VA and VA-PICA aneurysms is low, they should be considered for surgical treatment because they carry higher early mortality and morbidity after rupture. The transcondylar fossa approach provides adequate exposure of the aneurysm without permanent lower cranial nerve morbidity.