Objectives: Aneurysms of the lower basilar artery are surgically difficult to expose and clip. Various cranial base approaches, which are associated with significant morbidity, have been used to access this region. We have used the far-lateral approach without occipital condyle drilling for clipping of lower basilar junction aneurysms to assess the exposure for adequate visualization and clipping, and to study the complications and outcome. Design: Retrospective review of data. Setting: Between 1997 and 2001, four patients with lower basilar artery aneurysms were operated on at Louisiana State University Health Sciences Center in Shreveport. The far-lateral approach without drilling of the occipital condyle was used in each procedure. Participants: Cases of basilar artery aneurysms. Main Outcome Measures: Glasgow Outcome Scale (GOS) score. Results: All four aneurysms were clipped successfully. All patients had good outcome (GOS scores of 5 and 4). There were no instances of cerebrospinal fluid leakage or pseudomeningocele. Two patients experienced transient morbidity in the form of voice hoarseness and swallowing difficulty. Conclusion: The far-lateral approach without drilling of the occipital condyle adequately exposed the lower basilar artery for successful clipping of aneurysms and was associated with minimal morbidity
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