A Transcavernous-transsellar Approach to the Basilar Tip Aneurysms

Dolenc, Vinko V.; Škrap, Miran; Sustersic, J. L.; Škrbec, Miha; Morina, Arsim

doi:10.3109/02688698709035309

Cited by 212 publications

(136 citation statements)

References 30 publications

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“…Their higher morbidity has encouraged different surgical and endovascular approaches; nevertheless, treatment is still fraught with limitations, especially intraoperative and postoperative morbidity and, with endovascular methods, high rates of incomplete occlusion and late reopening 1,2,3,4,5,6,7,8,9,10 . Several series have reported the outcomes of patients undergoing surgical or endovascular treatment of basilar aneurysms 9,27 .…”

Section: Basilar Artery Aneurysms Account For Approximately 7%mentioning

confidence: 99%

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

Pahl

Oliveira

Rotta

2017

Arq. Neuro-Psiquiatr.

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Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

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Section: Basilar Artery Aneurysms Account For Approximately 7%mentioning

confidence: 99%

Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

Pahl

Oliveira

Rotta

2017

Arq. Neuro-Psiquiatr.

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“…46,49 Further division of the dura propria along the longitudinal axis of the optic nerve sheath and division of the distal dural ring allows further mobilization of the internal carotid artery to optimize optic nerve decompression and exposure of the optic nerve within the optic canal to facilitate intracanalicular tumor removal. [18][19][20] Tumor that is infiltrating the dura propria can also be removed. Using this technique, a 270° decompression from above can be achieved.…”

Section: Optic Canal Involvement In Tuberculum Sellae Meningiomasmentioning

confidence: 99%

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Liu¹,

Christiano²,

Patel³

et al. 2011

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101

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Tuberculum sellae meningiomas frequently extend into the optic canals. Radical tumor resection including the involved dural attachment, underlying hyperostotic bone, and intracanalicular tumor in the optic canal offers the best chance of a Simpson Grade I resection to minimize recurrence. Decompression of the optic canal with removal of the intracanalicular tumor also improves visual outcome since this portion of the tumor is usually the cause of asymmetrical visual loss. The purely endoscopic endonasal extended transsphenoidal approach offers a direct midline trajectory and immediate access to tuberculum sellae meningiomas without brain retraction and manipulation of neurovascular structures. Although the endoscopic approach has been previously criticized for its inability to remove tumor within the optic canals, complete Simpson Grade I tumor removal including intracanalicular tumor, dural attachment, and involved hyperostotic bone can be achieved in properly selected patients. Excellent visualization of the suprasellar region and the inferomedial aspects of both optic canals allows for extracapsular, extraarachnoid dissection of the tumor from the critical structures using bimanual microsurgical dissection. In this report, the authors describe the operative nuances for removal of tuberculum sellae meningiomas with optic canal involvement using a purely endoscopic endonasal extended transsphenoidal (transplanum transtuberculum) approach. They specifically highlight the technique for endonasal bilateral optic nerve decompression and removal of intracanalicular tumor to improve postoperative visual function, as demonstrated in 2 illustrative cases. Special attention is also given to cranial base reconstruction to prevent CSF leakage using the vascularized pedicled nasoseptal flap.

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“…These locations of meningiomas at the skull base may also be encountered within aberrant middle meningeal artery territory: sphenoid wing meningiomas, anterior clinoid process meningiomas, middle cranial fossa meningiomas, parasellar space meningiomas, SOF meningiomas, tuberculum sellae meningiomas, diaphragm sellae and optic canal(s) meningiomas, posterior clinoid process, dorsum sellae, upper clival meningiomas, Dorello's space meningiomas, and petroclival meningiomas [13]. Anterior clinoidectomy, either extradural [8] or intradural, is a crucial step during pterional approach to the central skull base used for clipping carotid-ophthalmic [12,33], giant internal carotid artery and paraclinoid aneurysms and upper basilar artery aneurysms [5,9], to gain entrance to the cavernous sinus for direct surgical management of carotid-cavernous fistulae, intracavernous aneurysms and parasellar macroadenomas, and for resection of extracavernous tumours such as craniopharyngiomas, periclinoid and suprasellar meningiomas [34], and giant pituitary adenomas. The relative increase in exposure of the optic nerve, internal carotid artery, and opticocarotid triangle by removal of the anterior clinoid process is well documented [14].…”

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confidence: 99%