Transpetrosal approach for aneurysms of the lower basilar artery

Abstract

Extradural subtemporal access to the petrosal ridge and a resection of the anterior pyramidal bone produced direct observation of the lower basilar artery, with minimum retraction of the temporal lobe and preservation of the temporal bridging veins. Two patients with lower basilar trunk aneurysms facing toward the brain stem, were operated on by the "transpetrosal approach," with successful clipping of the aneurysms. Auditory function was preserved in one case. This approach decreases the possibility of retraction damage to the temporal lobe, brain stem, or cranial nerves, and may be helpful for surgery of aneurysms arising around the vertebrobasilar junction or at the origin of the anterior inferior cerebellar artery.

Petrosal approaches to posterior circulation aneurysms

“…This summary excludes studies employing transsigmoid infratentorial approaches 12,17,46 and those with approaches sacrificing all or part of the labyrinth. 5,6,8,14,18,51,52,57 Anterior Petrosal Approach An extension of the middle fossa approach, 27 the anterior petrosal approach, originally described by Bochenek and Kukwa in 1975, 7 was initially applied to basilar aneurysms by Kawase in 1985. 31 Prior to the "Kawase approach," low-lying basilar apex and upper basilar trunk aneurysms would often be exposed via a subtemporaltranstentorial approach with added traction placed on the temporal lobe.…”

“…5,6,8,14,18,51,52,57 Anterior Petrosal Approach An extension of the middle fossa approach, 27 the anterior petrosal approach, originally described by Bochenek and Kukwa in 1975, 7 was initially applied to basilar aneurysms by Kawase in 1985. 31 Prior to the "Kawase approach," low-lying basilar apex and upper basilar trunk aneurysms would often be exposed via a subtemporaltranstentorial approach with added traction placed on the temporal lobe. 31,37,44 This approach provides the addition of an extradural petrous apicectomy.…”

“…31 Prior to the "Kawase approach," low-lying basilar apex and upper basilar trunk aneurysms would often be exposed via a subtemporaltranstentorial approach with added traction placed on the temporal lobe. 31,37,44 This approach provides the addition of an extradural petrous apicectomy. 7,31 A combined supra-and infratentorial exposure is afforded after dividing the tentorium posterior to the entry of the fourth cranial nerve and ligating and dividing the superior petrosal sinus with a perpendicular dural incision.…”

“…1,21,26,50,55 Lauded for their usage in the management of complex neoplastic lesions such as meningiomas, schwannomas, and chordomas, 1,10,13,[19][20][21]26,48,50,55 petrosal approaches have also been employed for decades in the management of complex cerebrovascular lesions, particularly posterior circulation aneurysms. 4,11,30,31,37,43,50 In this manuscript, we review the evolutionary application of the standard anterior and posterior petrosal approaches to complex posterior circulation aneurysms. …”

The Extreme Lateral Transcondylar Approach to Aneurysms of the Vertebrobasilar Junction, the Vertebral Artery, and the Posterior Inferior Cerebellar Artery

“…Even PICA aneurysms can be Vertebral artery aneurysms, PICA aneurysms, and aneurysms arising at the vertebrobasilar junction are treated via transpetrosal and transoral-transclival approaches. 12,13 The loss of auditory function and the risk of CSF fistula with subsequent meningitis are significant drawbacks of these approaches. '3-15 The usefulness of the extreme lateral transcondylar approach to intra-and extradural tumors located anterior to the neuroaxis in the region of the lower clivus and the foramen magnum was recently described.…”