title: Vertebrobasilar junction giant aneurysm: Lessons learned from a neurosurgical audit and anatomical investigation.
abstract: The treatment of vascular lesions of the vertebrobasilar junction (VBJ) remains a challenging task in the neurosurgical practice and the gold standard therapy is still under debate. In this article, the authors report a detailed postmortem study of a VBJ giant aneurysm (GA) previously endovascularly treated. Although the decision-making process for the vast majority of neurosurgical treatment can nowadays be accurately carried out during the preoperative planning (i.e., with the aid of neuroimaging fusion protocols, neuronavigation platforms, etc.) meant to maximize the anatomical understanding of the lesions and minimize possible intraprocedural challenges, this postmortem study represents the ultimate essence of neurosurgical audit as the laboratory investigations allowed to reevaluate the clinical history of VBJ GA, and reassess the multiple strategies available for its treatment with a straightforward anatomical perspective. Specifically, the lessons learned through this clinical and laboratory work uphold a great educational value regarding the complex management of those lesions, including the possible role of combined skull base surgical approaches.
authors.affiliation: a Department of Neurosurgery , Louisiana State University , New Orleans , Louisiana , USA.|b Department of Experimental Biomedicine and Clinical Neurosciences , Neurosurgical Clinic, AOPU "P. Giaccone" Universita' degli Studi di Palermo , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Graziano
authors.affiliation: a Department of Neurosurgery , Louisiana State University , New Orleans , Louisiana , USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Ganau
authors.affiliation: a Department of Neurosurgery , Louisiana State University , New Orleans , Louisiana , USA.
authors.forename: Vittorio Maria
authors.initials: VM
authors.lastname: Russo
authors.affiliation: b Department of Experimental Biomedicine and Clinical Neurosciences , Neurosurgical Clinic, AOPU "P. Giaccone" Universita' degli Studi di Palermo , Italy.
authors.forename: Domenico G
authors.initials: DG
authors.lastname: Iacopino
authors.affiliation: a Department of Neurosurgery , Louisiana State University , New Orleans , Louisiana , USA.
authors.forename: Arthur John
authors.initials: AJ
authors.lastname: Ulm
mesh_terms: D015901:Angiography, Digital Subtraction; D001344:Autopsy; D021721:Balloon Occlusion; D001488:Basilar Artery / Q000473:pathology* / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D008485:Medical Audit; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D014711:Vertebral Artery / Q000473:pathology* / Q000601:surgery*
keywords: anatomical dissection; neurosurgical audit; skull base approaches; vertebrobasilar junction aneurysms