After initial descriptions of a lateral sub-occipital approach1,2 to treat vertebral artery–posterior inferior cerebellar artery (VA–PICA) aneurysms, several authors3–5 des-cribed extreme-lateral or far-lateral approaches and their variants. These anatomic and surgical techniques are still applied today.
Extensive surgical approaches to the skull base have been avoided since several publications6,7 highlighted complications associated with the resection of the condyle and adjacent structures; experienced surgeons are now shifting from classic approaches to less invasive or minimally invasive surgeries. Recent advances in surgical devices, including better image definition and intraoperative management of imaging data, have allowed practitioners to use smaller surgical openings with similar or even better patient outcomes.2,8
Currently, we prioritize use of the far-lateral approach with intact occipital condyle for clipping VA–PICA aneurysms. In this study, we present the results of this approach on a large series of patients with VA–PICA aneurysms.
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