Transcondylar Fossa Approach for the Treatment of Vertebrobasilar Aneurysms: Extent of Resection of Condyle and Jugular Tubercle

Objective: Various approaches to vertebrobasilar junction (VBJ) have been used to treat vascular lesions. Extent of resection of the occipital condyle and jugular tubercle has been regarded as a critical process. In a retrospective manner, we evaluated the extent of bony resection in patients with aneurysms around the VBJ.

Design: Retrospective case series.

Patients/Methods: Seventeen patients were enrolled. Among them, 14 patients had saccular aneurysms and 3 had dissecting aneurysms. Subarachnoid hemorrhage was the presenting symptoms in nine patients. Anatomical aspects of the condylar fossa were evaluated preoperatively and postoperatively using 3-dimentional computed tomography. We also reviewed operative videos and medical records.

Results: In 10 patients with saccular aneurysms, the aneurysms were clipped without resection of the occipital condyle, and in 4 patients, partial resection of the condyle and jugular tubercle was necessary. In all patients with dissecting aneurysms, trapping was performed without resection of the other bony structures except the condylar fossa.

Conclusions: The transcondylar approach, which requires resection of the condyle, seems to not be essential for the treatment of the VBJ aneurysms. The condylar fossa approach with no or minimal resection of the condyle provides essential operative space.