Extreme Lateral Infracondylar Approach for Occipital Artery to Vertebral Artery (V3) Bypass for Vertebrobasilar Insufficiency

Vertebrobasilar insufficiency can be refractory to medical therapy. Surgical revascularization may augment posterior circulation perfusion. We present a 39-year-old with recurrent posterior circulation strokes due to bilateral vertebral artery occlusion and compromised collateral circulation. Patient underwent OA-V3 bypass via an extreme lateral infracondylar approach to restore vertebrobasilar perfusion. This skull base approach offers distinct advantages, utilizing a minimally invasive technique through a small retromastoid incision without intradural exposure and or need for an intervening graft. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany