Subscribe to RSS
DOI: 10.1055/s-2001-14441
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662
Microsurgical and Endoscopic Approaches to the Basilar Bifurcation: Quantitative Comparison of Combined Pterional/Anterior Temporal and Orbitozygomatic Extended Approaches
Publication History
Publication Date:
31 December 2001 (online)
![](https://www.thieme-connect.de/media/sbs/200102/lookinside/thumbnails/10.1055-s-2001-14441-1.jpg)
ABSTRACT
To determine the most effective route to the upper third of the basilar artery, 10 cadaver dissections were performed comparing the exposure gained using the combined pterional/anterior temporal approach and the orbitozygomatic extended approach. Endoscopic evaluation through an eyebrow incision in each dissection helped determine whether any advantage was conferred by the cranial base approach. This also served to assess the benefit of using the endoscope as an adjunct to open procedures in evaluating the opticocarotid and retrocarotid routes to the basilar artery. The results of cadaveric dissections suggest that compared with the exposure afforded by the combined pterional/anterior temporal approach, the orbitozygomatic extended approach yields an increase of 8 cm in the anteroposterior axis and 10 cm in the superoinferior axis. Furthermore, as expected, the increases in visibility were directed anteriorly and posteriorly. When employed through the craniotomy site during aneurysm clipping, endoscopy was found to be potentially useful in assessing the contralateral elements of the upper basilar complex.
KEYWORD
Basilar artery - aneurysm - orbitozygomatic - endoscope - pterion
REFERENCES
- 1 Drake C. Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg . 1961; 23 230-238
- 2 Yasargil M G, Antic J, Laciga R. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol . 1976; 6 83-91
- 3 Samson D S, Hodosh R M, Clark W K. Microsurgical evaluation of the pterional approach to aneurysms of the distal basilar circulation. Neurosurgery . 1978; 3 135-141
- 4 Drake C G. The surgical treatment of aneurysms of the basilar artery. J Neurosurg . 1968; 29 436-446
- 5 Sano K. Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note. Neurol Res . 1980; 2 361-367
- 6 Dolenc V V, Skrap M, Sustersic J. A transcavernous-transsellar approach to the basilar tip aneurysms. Br J Neurosurg . 1987; 1 251-259
- 7 Neil-Dwyer G, Sharr M, Haskell R. Zygomaticotemporal approach to the basis cranii and basilar artery. Neurosurgery . 1988; 23 20-22
- 8 Shiokawa Y, Saito I, Aoki N, Mizutani H. Zygomatic temporopolar approach for basilar artery aneurysms. Neurosurgery. 1989; 25 793-797
- 9 Pitelli S D, Almeida G G, Nakagawa E J. Basilar aneurysm surgery: the subtemporal approach with section of the zygomatic arch. Neurosurgery . 1986; 18 125-128
- 10 Neil-Dwyer G, Lang D A, Evans B T. The effect of orbitozygomatic access for ruptured basilar and related aneurysms on management outcome. Surg Neurol. 1997; 47 354-359
- 11 Fujimoto Y, Ikeda H, Yamamoto S. Pterional transcavernous approach for large basilar tip aneurysm-significance of the exposure of Dolenc's triangle. Surg Cereb Stroke . 1992; 20 191-195