A successful approach to vertebrobasilar aneurysms

Litvak, John; Sumners, Thomas C.; Barron, James L.; Fisher, Larry S.

doi:10.3171/jns.1981.55.3.0491

Cited by 25 publications

(4 citation statements)

References 8 publications

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“…Surgical results and outcomes were in most of cases acceptable (12,(20)(21)(22)(23)(24)(25)(26)(27)(28) . Nevertheless, Drake et al (29) , Hashi et al (30) , Saito et al (9) , Matricali et al (31) , and Hayakawa et al (32)(33)(34) reported 5 casualties related to surgery but the most common complications were CSF leak (Figure 3) and meningitis.…”

Section: Revival Of the Transoral-transclival Approachmentioning

confidence: 99%

“…However, the most dangerous event was the possibility that the clip could move away from the neck of the aneurysm. Indeed, in two cases, Saito et al (9) and Litvak et al (25) , showed that the head of the clip was larger than the bone window in the clivus and, for this reason, the clip slipped out from the aneurysm neck, causing death of the patient in one case. Concerning the reconstruction technique, in 1979, Yamaura et al (23) published a notable work describing the In the next years, Archer et al (35) , de Los Reyes et al (36) , and Crockard et al (37,38) described a modifi cation of the transoraltransclival route involving a Le Fort I osteotomy (maxillotomy) rather than splitting the soft and hard palates, off ering a much improved view of the clivus.…”

Section: Revival Of the Transoral-transclival Approachmentioning

confidence: 99%

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

Somma¹,

Notaris²,

Ensenat³

et al. 2014

Rhin

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Objective: A review of the main studies that have explored the use of the ventral pathway for treatment of intracranial aneurysms,including the recent reported extended transsphenoidal approaches. Methods: A comprehensive literature review was performed using the PubMed database. We recovered 48 cases of cerebral aneurysms, approached via the transcervical-transclival, transoral-transclival, transfacial-transclival ventral pathways and the extended transsphenoidal route. The overall rates of complications and surgical success were evaluated and compared for both traditional ventral and transsphenoidal approaches. Results: For traditional routes, the overall complications and surgical success rates were 74% (26/35) and 87% (13115), respectively.For extended transsphenoidal approaches were 44% (4/9) and 78% (7 /9), respectively. Conclusion: 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.

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Section: Revival Of the Transoral-transclival Approachmentioning

confidence: 99%

Section: Revival Of the Transoral-transclival Approachmentioning

confidence: 99%

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

Somma¹,

Notaris²,

Ensenat³

et al. 2014

Rhin

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“…The majority of the authors use a midline longitudinal incision of the pharyngeal wall not only in cranioTransoral operations for craniospinal malformations 205 spinal malformations, but also in cases of tumours and traumatic lesions. Exceptionally, a curved incision forming a flap is recommended in aneurysms [15,39] or tumours [2,43]. According to our experience a longitudinal incision has been adequate for the removal of space-occupying bone.…”

Section: Discussionmentioning

confidence: 99%

“…Originally the approach was used in treatment of infections of the upper cervical spine [19,49,63]. Up to now numerous communications exist, which recommend this approach for the treatment of basilar aneurysms [15,16,31,32,39,47,50,51,52,64,69,70], ventrally situated craniospinal tumours [2,5,9,10,25,27,36,38,42,43,44,46,53,57,61,64,65,68], and for the fusion or resection of fractured parts in craniospinal traumatic lesions [4,10,17,18,19,22,24,29,30,33,34,40,46,58,62,64]. This approach also allows a direct treatment of...…”

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confidence: 99%

Transoral operations for craniospinal malformations

Gilsbach

Eggert

1983

Neurosurg. Rev.

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The transoral approach to the lower third of the clivus and to the ventral aspect of the upper cervical spine is used in craniospinal malformations with or without dislocation as well as in basilar aneurysms, ventrally situated cranio-spinal tumours, fractures of the odontoid process, and in rheumatoid arthritis compressing the spinal cord. In consideration of the literature and ten personal cases the indications and techniques of the transoral approach in craniospinal malformations are discussed. According to our own experiences and those of other authors it is possible to expose the lower clivus and the cervical spine down to C2 by a midline incision of the pharyngeal wall using a mouth retractor and oral intubation. Splitting of the soft palate or resection of the hard palate are not necessary, a tracheotomy should be performed only in exceptional cases. In congenital craniospinal malformations without dislocation or instability causing a ventral compression of the spinal cord, for instance by the odontoid process, the transoral decompression is preferable to dorsal decompressing operations. In cases of pure instability without any space-occupying lesion the transoral and posterior approach are possible in order to perform a fusion. The last one seems more advantageous in these cases. In craniospinal malformations with dislocation causing a ventral and dorsal narrowing of the spinal canal, apart from the decompression a stabilization has to be achieved. In these usually complex malformations individual treatment is necessary. According to the rare cases in the literature and to our own experience a primary anterior decompression, followed by a most careful posterior stabilization seems to produce the most favourable results.

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Craniotomy for Aneurysm

Fox¹

1983

Intracranial Aneurysms

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A successful approach to vertebrobasilar aneurysms

Abstract: ✓ The authors present a surgical technique for approaching vertebrobasilar area aneursysm. The dural and clival defect is obliterated by means of a live vascularized muscle flap. A regimen of antimicrobial prophylaxis is described.

Cited by 25 publications

References 8 publications

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

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

Transoral operations for craniospinal malformations

Craniotomy for Aneurysm

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