Document Detail

Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms.
MedLine Citation:
PMID:  19770545     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Basilar apex aneurysms (BAA) are located in interpeduncular cistern surrounded by eloquent neurovascular structures. Surgical access is difficult due to narrow surgical corridors and requires traversing through a depth of 6-8 cm of subarachnoid space. AIM: Surgical management of BAAs clipped using frontotemporal craniotomy, orbitozygomatic osteotomy with combined subtemporal and transylvian (half and half) approach is discussed. SETTING AND DESIGN: Tertiary care referral institute; prospective study. MATERIALS AND METHODS: Five patients with BAA rupture causing subarachnoid hemorrhage presented in modified Hunt and Hess (Hand H) grades II (n=1), III (n=1) and IV (n=3), respectively. In 4 patients, the aneurysms were 0.8-1.2 cm in diameter, situated 7 mm-1 cm above dorsum sellae. Two of them had posteriorly projecting aneurysms. One patient had a giant, high BAA with a left parietooccipital arteriovenous malformation. Vasospasm of posterior cerebral/proximal basilar artery was seen in 2 patients. In one patient, internal carotid artery was mobilized by intradural anterior clinoid drilling with carotid collar division. Triple-H therapy was administered following surgery. RESULTS: There was no intraoperative rupture or temporary clipping. Follow up angiography showed complete aneurysmal obliteration with preservation of posterior cerebral and superior cerebellar arteries. Follow up (mean: 8.7+/-3.5 months) H and H grades were II (n=2) and III (n=3), respectively. The morbidity include caudate and thalamic region infarct, transient III rd nerve palsy and cerebrospinal fluid otorrhoea (n=1, respectively). CONCLUSIONS: This simple approach provides a wide surgical corridor from 5 mm below to greater than 1 cm above dorsum sellae with adequate proximal control of basilar artery. It is an option to endovascular embolization especially with large and giant, or wide-necked BAA, vertebrobasilar tortuosity, coil compaction or postcoiling re-rupture and an associated large haematoma.
Sanjay Behari; Rupant K Das; Awadhesh K Jaiswal; Vijendra K Jain
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurology India     Volume:  57     ISSN:  0028-3886     ISO Abbreviation:  Neurol India     Publication Date:    2009 Jul-Aug
Date Detail:
Created Date:  2009-09-22     Completed Date:  2009-11-10     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0042005     Medline TA:  Neurol India     Country:  India    
Other Details:
Languages:  eng     Pagination:  438-46     Citation Subset:  IM    
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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MeSH Terms
Basilar Artery / radiography,  surgery*
Cerebral Angiography / methods
Craniotomy / methods*
Frontal Bone / surgery*
Intracranial Aneurysm / radiography,  surgery*
Magnetic Resonance Imaging / methods
Middle Aged
Outcome Assessment (Health Care)
Surgical Instruments
Temporal Bone / surgery*
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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