Indications Corridor And Exposure: The orbitozygomatic transsylvian approach is ideal for basilar tip aneurysms (BTAs) ≤15 mm located at or above the level of posterior clinoid process (PCP), whereas for larger, low-lying BTA's with fetal posterior cerebral artery (PCA), the subtemporal transzygomatic approach is preferred. Both approaches expose the basilar tip area and structures in the interpeduncular fossa from an anterolateral angle and the lateral angle, respectively.
Anatomic Essentials Need For Preoperative Planning And Assessment: Aneurysm size and level, brainstem perforators, and PCA size (fetal or not) should be noted preoperatively.
Essential Steps Of The Procedure: A. Orbitozygomatic transsylvian approach1. Frontotemporal craniotomy with posterolateral orbitotomy.2. Extradural optic nerve decompression and anterior clinoidectomy.3. Transsylvian dissection and carotid-optic cistern decompression.4. Distal dural ring opening.5. Aneurysm exposure and clipping.OrB. Subtemporal transzygomatic approach 11. Frontotemporal incision with zygomatic osteotomy.2. Temporal lobe retraction, subtemporal dissection, and tentorial division.3. Cavernous sinus opening and dorsum sellae drilling.4. Petrous apex resection.5. Aneurysm exposure and clipping.
Pitfalls/avoidance Of Complications: Complications such as cranial nerve injury, perforator stroke, aneurysm rupture, and hemorrhage can be prevented by neuromonitoring, avoiding temporary basilar occlusion for >10 minutes, use of transient adenosine arrest during clipping, and interposing rubber dam between perforators and aneurysm. 1.
Variants And Indications Of Their Use: Cavernous sinus opening with posterior clinoidectomy and dorsum sellae drilling may be performed if aneurysm neck is at or below the level of PCP. 1-7The patient consented to the procedure.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1227/ons.0000000000000655 | DOI Listing |
World Neurosurg
February 2024
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address:
Aneurysms at the superior cerebellar artery (SCA) are commonly treated endovascularly because of their location around the basilar artery, but they are not intimately related with thalamoperforators. Therefore in younger patients, those with wide-necked aneurysms, or those with multiple ipsilateral aneurysms, surgery remains a treatment option. We present a 52-year-old woman with dizziness in whom multiple, unruptured intracranial aneurysms were identified.
View Article and Find Full Text PDFWorld Neurosurg
November 2023
Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil. Electronic address:
Adamantinomatous craniopharyngioma (ACP) is a rare sellar region tumor seen in 0.5-2 cases per million persons each year, presenting a bimodal distribution that peaks at 5-15 years in children and 45-60 years in adults. Arising from embryonic remnants of the Rathke pouch epithelium, ACPs are associated with calcifications in 90% of cases and grow cranially toward the floor of the diencephalon.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
July 2023
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Indications Corridor And Exposure: The orbitozygomatic transsylvian approach is ideal for basilar tip aneurysms (BTAs) ≤15 mm located at or above the level of posterior clinoid process (PCP), whereas for larger, low-lying BTA's with fetal posterior cerebral artery (PCA), the subtemporal transzygomatic approach is preferred. Both approaches expose the basilar tip area and structures in the interpeduncular fossa from an anterolateral angle and the lateral angle, respectively.
Anatomic Essentials Need For Preoperative Planning And Assessment: Aneurysm size and level, brainstem perforators, and PCA size (fetal or not) should be noted preoperatively.
Oper Neurosurg (Hagerstown)
May 2023
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg
March 2023
Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
Background: Lesions involving the cavernous sinus (CS) represent some of the most challenging pathologies of the skull base owing to the dense traversing and surrounding neurovasculature. Extradural exposure and preparation of this region, whether as initial preparation for a combined intra-extradural approach or as the main avenue of surgical exposure, can enlarge surgical corridors and minimize the need for brain retraction in this very confined space. We provide a detailed assessment of the entry corridors to the CS that are available within each approach, the surgical exposure and freedom provided by each of these corridors, and demonstrate how extradural and intradural preparation of these corridors can be used to widen the available working space and facilitate surgery.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!