Repair of an Aneurysm of the Basilar Artery by a Transclival Approach

We recommend the standard retrosigmoid approach for treating small to medium aneurysms involving the lower two-thirds of the clivus or distal AICA aneurysms. Cranial base approaches are recommended for large or giant aneurysms or for those proximal to the emergence of the AICA from the basilar trunk. Hypothermic cardiac arrest facilitates dissection of giant aneurysms. Endovascular treatment is a useful adjunct for treating residual aneurysms but did not provide definitive treatment in any of our patients.

show abstract

“…We do not use a transoral-transfacial approach for any of these aneurysms, although its use has been reported (7,18,34,37,58).…”

Section: Relation Of Aneurysm Size and Location To Surgical Approachmentioning

confidence: 98%

Anteroinferior Cerebellar Artery Aneurysms: Surgical Approaches and Outcomes—A Review of 34 Cases

et al. 2004

View full text Add to dashboard Cite

show abstract

“…First used by otolaryngologists for the drainage of retropharyngeal abscesses, this route was extended for the treatment of spinal caries and atlanto-axial fractures by Southwick and Robinson (1957) and by Fang and Ong (1962). Since then it has been used in neurosurgery for basilar aneurysms (Fox, 1967;Wissinger et al, 1967) and also to remove a number of chordomas (Mullan et al, 1966;Arana-Iniguez et al, 1968;Guthkelch and Williams, 1972). Subluxation and destruction of the odontoid from a metastasis (carcinoma of the breast) has been treated successfully by transoral excision and grafting (Laurence, 1969).…”

Section: Discussionmentioning

confidence: 99%

Cervical chordoma: Report of a case and the technique of transoral removal

Windle-Taylor

1977

Journal of British Surgery

View full text Add to dashboard Cite

SUMMARYA case of cervical chordoma in a man of 27 years is described. The clinical features were of progressive spinal cord compression. Treatment was by transoral decompression of the second cervical vertebra and postoperative radiotherapy. The result was favourable and remained so at follow-up after 27 months. The relative merits and scope of the various approaches to the upper cervical vertebrae and the role of radiotherapy and chemotherapy are discussed. CHORDOMA is a rare tumour of the axial skeleton whose clinical features bring it within the scope of the ophthalmologist, otolaryngologist, neurosurgeon, orthopaedic surgeon and general surgeon.Since its identification in 1856 by Luschka, about 1000 cases have been reported and about 10-15 new cases are described each year. The most comprehensive recent review (Utne and Pugh, 1955) covers 505 cases from the world literature and 72 cases from the Mayo Clinic.Clinical features Statistically, chordoma accounts for 5 per cent of all benign bone tumours (Coley, 1960), less than 2 per cent of all nasopharyngeal tumours (Osborn, 1975) and less than 1 per cent of all central nervous system neoplasms (Poppen and King, 1952). The origin of a chordoma is from the notochord or its remnants (Wright, 1967).Any age group may be affected, though the peak incidence is in middle age. The sex distribution is not clear-cut, the series varying in their results. Most chordomas affect the craniocervical or the sacrococcygeal regions.The pathology and histology have been well described by Steegman (1971) and the ultrastructure by Gessaga et al. (1973). Metastasis is rare in head and neck chordoma but it may be local to lymph nodes or within the central nervous system (Holzner, 1954). Histology shows malignant features, but these correlate poorly with clinical behaviour.The diagnosis depends on radiological and histological findings. The clinical picture is one of a local space-occupying lesion arising in bone, usually without local or distant metastasis. Systemic features are undiagnostic, though lassitude and weight loss are fairly frequent. The results of haematological, serological and biochemical investigations are usually normal. There are no specific radiological changes that differentiate a chordoma from other bone tumours. Plain radiography with tomography and contrast studies are of great benefit in defining spread and involvement. Angiography is useful in that it not only excludes other pathological conditions, but also gives some indication as to the vascularity of the tumour.A biopsy may be a prelude to or accompany definitive surgery. Much has been made of the difficulty in diagnosis (Higinbotham et al., 1967), but given a good specimen, the features are unmistakable. TreatmentIncreasing optimism has been shown concerning the role of radiotherapy (Rosenqvist and Saltnan, 1959;Windeyer, 1959) as operation alone has proved inadequate. The latest reviews (Pearlman and Friedman, 1970; Pearlman et a]., 1972; Phillips and Newman, 1974) suggest that a combination of radical op...

show abstract

“…For such reason, several authors, over the past 50 years, began to plan alternative routes to get access to aneurysms arising from the midline posterior circulation. As a matter of fact, the ventral pathway was considered a reasonable alternative, because it permits direct access to the surgical field with exposure and dissection of the aneurysm from the surrounding neurovascular tissue, obviating brain retraction and obtaining an early and safe proximal and distal vascular control (1,(8)(9)(10)(11)(12)(13) . More recently, with the advent of transsphenoidal surgery and, in particular, with the rapid development of the endoscopic endonasal technique, the interest in extended transsphenoidal approaches has been renewed for many pathological entities (14,15) .…”

Section: Introductionmentioning

confidence: 99%

The ventral route to intracranial aneurysm: from the origin towards modern transsphenoidal surgery. An historical review and current perspective

Somma¹,

Notaris²,

Enseñat³

et al. 2014

Rhin

View full text Add to dashboard Cite

Our paper is a reconnaissance of what has been done via "the anterior route" and a notification of the existence of this "surgical window': Present and future of cerebral aneurysm treatment is represented by the endovascular technique. A few selected cases in specialized centers, where transsphenoidal approaches with the aid of the endoscope are routinely performed,may be treated with such techniques alone or in combination with other different procedures. Further studies in large numbers of patients will be required to validate the full benefit of this approach.

show abstract

Repair of an Aneurysm of the Basilar Artery by a Transclival Approach

Cited by 56 publications

References 6 publications

Anteroinferior Cerebellar Artery Aneurysms: Surgical Approaches and Outcomes—A Review of 34 Cases

Anteroinferior Cerebellar Artery Aneurysms: Surgical Approaches and Outcomes—A Review of 34 Cases

Cervical chordoma: Report of a case and the technique of transoral removal

The ventral route to intracranial aneurysm: from the origin towards modern transsphenoidal surgery. An historical review and current perspective

Contact Info

Product

Resources

About