Midline aneurysms of the vertebrobasilar junction: an effective anterior approach

There are acknowledged difficulties associated with operations on midline aneurysms at the vertebrobasilar junction. This report describes a series of such aneurysms treated by an anterior approach using a Le Fort maxillotomy to gain access via the clivus to the aneurysm. In each case the aneurysm was dealt with satisfactorily with no long-term morbidity or mortality. Attention is directed to the necessity for a water-tight dural seal postoperatively. We advocate wider use of this technique in appropriate circumstances.