• Mardjono Tjahjadi, Mika Niemelä, Juri Kivelev, Joseph Serrone, Hidetsugu Maekawa, Behnam Rezai Jahromi, Oleg Kerro, Ahmad Hafez, Hanna Lehto, Riku Kivisaari, and Juha Hernesniemi.
• Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: joy_mardjono@yahoo.com.
• World Neurosurg. 2016 Aug 1; 92: 313-322.

ObjectiveThe presigmoid approach can be used to treat vertebrobasilar artery aneurysms when circumstances require more operative exposure. High morbidity and mortality in these cases have been reported. In this study, we describe our modified presigmoid approach for vertebrobasilar artery aneurysms and our clinical results.MethodsThis series includes patients with vertebrobasilar aneurysms clipped via the modified presigmoid approach at the Department of Neurosurgery at Helsinki University Hospital from 1998 to 2014. Data were collected from the operating record books, patients' medical records, and a radiologic database server.ResultsThirty-three presigmoid procedures of 31 patients were performed to treat 34 aneurysms (14 ruptured, 20 unruptured). The aneurysms had a mean distance from the posterior clinoid process to the aneurysm neck of 12.2 mm (range, 0-26.6 mm). A favorable outcome was achieved in 21 patients (64%). A favorable outcome was achieved in 74% of unruptured and good-grade patients, whereas favorable outcome was achieved in only 36% of poor-grade patients. Complete or near-complete occlusion was achieved in 79%. Larger aneurysms, fusiform morphology, and anterior dome projection had lower occlusion rates.ConclusionsWe have described our experiences of using the presigmoid approach to treat vertebrobasilar aneurysms. The clinical and radiographic results are acceptable given the complex location and configuration of the treated aneurysms. Unfavorable outcomes are related to the poor admission Hunt and Hess grade, aneurysm morphology, and aneurysm size.Copyright © 2016 Elsevier Inc. All rights reserved.

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