A modified anterior temporal approach for low-position aneurysms of the upper basilar complex

Abstract

Background:Although surgery for aneurysms of the upper basilar complex is generally accomplished by a pterional or subtemporal approach, both techniques have disadvantages. Therefore, attempts have been made to combine both the approaches, such as an anterior temporal approach, which exposes the anterior aspect of the temporal lobe during standard fronto-temporal craniotomy. However, in all these techniques, the temporal vein is sacrificed to allow posterior retraction of the temporal lobe, which may cause venous infarction in the temporal lobe.Methods:Our institutional review board approved this prospective study. We modified the anterior temporal approach for low-position aneurysms of the upper basilar complex by performing posterior clinoidectomy as necessary, thereby preventing the sacrifice of all vessels.Results:From 2007 to 2014, seven patients were operated on using this modified approach, and four patients underwent additional posterior clinoidectomy. Complete clip ligation was performed for all aneurysms without sacrificing any vessels, and there were no permanent complications attributable to manipulation for clipping or posterior clinoidectomy.Conclusions:The modified anterior temporal approach allows a wider operating field within the retro-carotid space, without sacrificing any vessels, and permits safer posterior clinoidectomy and aneurysm clipping in patients with low-position aneurysms of the basilar complex.

Anterior temporal approach for clipping of ruptured basilar tip aneurysms: Surgical techniques and treatment outcomes

“…e distinctive point of this approach is the posterolateral retraction of the temporal lobe without sacrificing venous drainage of the Sylvian vein to the base of skull and with less tension to the main trunk of the middle cerebral artery than with the previously described techniques. [6][7][8]13,22,23,34] Several published studies of open surgery for BT aneurysms with various preoperative conditions, surgical approaches and postoperative outcomes are shown in Table 2. [11,15,17,[19][20][21][22][23]30,31,35] Most of these were studied in patients with a high percentage of unruptured cases.…”

“…A well-known pterional transsylvian approach by Yasargil et al [38] and a subtemporal approach by Drake [4] have been commonly used by most neurosurgeons. Later-developed approaches are combinations of the pterional and subtemporal approaches, such as the temporopolar approach by Sano, [29] the pretemporal transzygomatic transcavernous approach by Krisht and Kadri, [16] the extended lateral (half-and-half) approach by Drake [5] and Bendok et al, [2] the pterional/anterior temporal approach by Heros and Lee, [10] the pretemporal approach by de Oliveira et al, [3] and the transsylvian-trans-uncal approach by Post et al [28] e anterior temporal approach, which is also called the modified distal transsylvian approach, was developed for approach to the upper basilar artery [6][7][8]13,22,23,34] in the anterolateral direction and for access to an aneurysm arising from the posterior wall of the ICA. [37] is approach allows a wide corridor through the retrocarotid space to the upper basilar region by posterolateral retraction of the temporal lobe without sacrificing any veins.…”

“…[37] is approach allows a wide corridor through the retrocarotid space to the upper basilar region by posterolateral retraction of the temporal lobe without sacrificing any veins. [13] Good results have been reported, but the majority of these reports involved unruptured cases. [22,23] e aims of our study were to evaluate the surgical outcomes and surgical complications and to describe the surgical techniques of the anterior temporal approach for clipping the ruptured BT aneurysms with illustrative cases.…”

Radical resection of a craniopharyngioma via the extradural anterior temporal approach with zygomatic arch osteotomy

“…The intradural manipulations in the EDATA, such as dissection of the arachnoid trabeculae in between the uncus and the oculomotor nerve, and retraction of the temporal lobe posterolaterally, are similar to those in the anterior temporal approach. The anterior temporal approach,[ 12 19 ] which is a variation of the trans-sylvian approach, can provide a better lateral view than the trans-sylvian approach, and can, better use the retrocarotid space. However, this approach is limited by the running course of the ICA, and sometimes by the sphenoparietal sinus.…”

A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery

“…For example, the anterior temporal approach for aneurysms of the ICA and basilar artery requires wide opening of the sylvian fissure, in which the anterior temporal artery needs to be dissected from the medial surface of the temporal lobe to mobilize the temporal lobe. [ 2 4 ] As well as aneurysmal surgery, kinking of the PICA, AICA, or superior cerebellar artery branches may occur with MVD for not only GPN, but also for hemifacial spasm, as well as trigeminal neuralgia. To achieve appropriate transposition, it is not enough to insert the prosthesis at only the REZ.…”