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Aneurysms of the posterior circulation have always proved a challenge to the neurosurgeon. In 1948, Schwartz reported a successful trapping of a large basilar artery aneurysm, but Drake, in 1961 was the first to report direct surgical repair of a ruptured basilar aneurysm in 4 patients [6]. He concluded that ˵direct surgical attack was feasible and worthwhile under exceptional circumstances, when life was threatened by repeated haemorrhages″. With the introduction of the operating microscope, improved micro-instruments and clips and advances in neuro intensive care, surgical repair of such aneurysms became the accepted norm, but outcome figures for repair if basilar tip and trunk aneurysms were always worse than for repair of aneurysms in the anterior circulation. As a result, with the introduction of coil embolisation in the 90s, early series of endovascular treatment always included a high proportion of posterior circulation aneurysms. In many centres (including Glasgow) an endovascular approach has become the first line of treatment for such aneurysms and standard coiling has been supplemented by the possibility of balloon remodelling or stenting. Despite this management approach, a proportion of the patients still require direct surgical repair due to technical failure or repeated coil impactions. [ABSTRACT FROM AUTHOR]

Microneurosurgical anatomy and principles of microneurosurgery are the essence of neurosurgical training. Apart from basic theoretical knowledge, a competent neurosurgeon should be trained to be capable of operating in small and often narrow and deep gaps. Their aim should be to perform minimally invasive procedures in almost bloodless fields. Prof. Yașargil emphasized that profound knowledge of the microneurosurgical anatomy is acquired in cadaveric laboratories, and gentle handling of cerebral arteries and veins is acquired by performing microvascular anastomoses in rats and mice [11]. Both training facilities could be – admittedly with considerable effort – installed in many hospitals to support a variety of microsurgeons. However, cadaveric dissections may be deemed impossible for cultural, religious, economical, or other reasons (Fig. 1). [ABSTRACT FROM AUTHOR]