Aneurysms of the posterior circulation

The management of aneurysm in the vertebrobasilar circulation post difficult challanges in complex aproaches. The preparation of the patient should proceed with an initial thorough medical and neurlogical assement to establish a clear and trouble free pathway to the surgical procedure. A careful monitoring of hemodynamic properties of the systemic circulation, normalization of all cardiac function and optimization of medical condition is required. An arterial line, central venous line, a Swan-Ganz catheter, the recording of cardiac output, cardiac index, urinary output, and cerebral perfusion pressure are considered very important in the management of these patients. Different surgical alternatives including supratentorial approaches via the pterional or the subtemporal area, suboccipital approaches through a midline, lateral transmatoid or asterional approach and transbasilar approaches through the clivus, petrous bone or mastoid are descried. Risks and potential complications are reviewed and alternatives are discussed.