Cranial base approaches to posterior circulation aneurysms

Day, John D.; Fukushima, Takanori; Giannotta, Steven L.

doi:10.3171/jns.1997.87.4.0544

Cited by 131 publications

(47 citation statements)

References 27 publications

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“…= posterior. craniovertebral junction parallel to the intracranial course of the VA. 9 Structures of the inferior aspect of the CPA and the cerebellomedullary angle are visualized. Sharp arachnoid dissection is performed and the following structures can be visualized: the fifth through 12th cranial nerves; the basilar artery; the VA; the vertebrobasilar junction; the posterior inferior cerebellar artery; and the anterior inferior cerebellar artery (Fig.…”

Section: Neurosurg Focus / Volume 19 / August 2005mentioning

confidence: 99%

Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction

Liu

Couldwell²

2005

FOC

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Neurenteric cysts are rare benign lesions of the central nervous system that are lined by endodermal cell–derived epithelium. Although they occur mostly in the spine, they can occur intracranially, most often in the posterior fossa. Neurenteric cysts that are located in the anterior cervicomedullary junction are even rarer and often require a skull base approach for adequate resection. The authors describe two cases of neurenteric cysts arising from the cervicomedullary junction that were resected via a far-lateral transcondylar approach. They discuss the surgical approach and operative nuances involved in removing these lesions, and review the clinical presentation of neurenteric cysts in this region as well as the neuroimaging characteristics, histopathological findings, and surgical management. Intraoperative videos are presented.

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Section: Neurosurg Focus / Volume 19 / August 2005mentioning

confidence: 99%

Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction

Liu

Couldwell²

2005

FOC

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“…55 In our review of the literature, we found 34 cases of posterior circulation aneurysms treated via the standard retrolabyrinthine posterior petrosal approach reported in 14 studies over the course of 2 decades (Table 3). 3,6,11,12,14,22,24,32,40,42,43,50,54,56 All aneurysms were completely occluded. In addition, although early morbidity was high (62%; 41% in the form of cranial nerve deficits), it was often transient.…”

Section: Posterior Petrosal Approachmentioning

confidence: 90%

“…A summary of demographic and outcome data for 61 patients with posterior circulation aneurysms treated via a petrosal approach in 23 reports spanning 3 decades is provided in Table 1. 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.…”

Section: Historical Perspectivementioning

confidence: 99%

Petrosal approaches to posterior circulation aneurysms

Gross

Tavanaiepour²,

Du³

et al. 2012

FOC

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Complex posterior circulation aneurysms are formidable lesions with an abysmal natural history. Their management continues to present a challenge to both endovascular and open microsurgical approaches. Affording an expansive, combined supra- and infratentorial exposure, the petrosal approaches are well suited for these challenging lesions when located along the basilar trunk or at a low-lying basilar apex. This report evaluates the evolution and application of petrosal approaches to these lesions. Excluding transsigmoid, infratentorial, or labyrinth-sacrificing approaches, the authors found 23 reports with 61 posterior circulation aneurysms treated via a petrosal approach. Although early morbidity was not negligible, rates of aneurysm occlusion (95% overall) and long-term outcome were quite laudable in light of the challenge posed by these lesions. Moreover, with accumulating experience with petrosal approaches, rates of complications are likely to wane, as neurosurgeons capitalize on the expansive exposure afforded by these indispensable approaches.

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“…Altough the lateral suboccipital approach associated to resection of posterior arch of C1 is considered feasible, definitely, it is not the best way to achieve an adequate exposure of vertebral artery, anterior and lateral medulla regions 1,3,12,13 . In order to perform a perfect exposure with minimal retraction of neural structures there have been purposed, adding to the lateral suboccipital approach, a partial mastoidectomy with lateral exposure of sigmoid sinus as well as the resection of the posterior arch of atlas and exposition of its transverse foramen beyond the neural and vascular structures inside the suboccipital triangle 2 .…”

Section: Discussionmentioning

confidence: 99%

“…When the intention is reaching anterior and lateral medulla regions as in lower clivus tumors, inferior third basilar artery and vertebral basilar junction aneurysms the best choice is performing a far lateral craniotomy 3 .…”

mentioning

confidence: 99%

The far-lateral craniotomy: tips and tricks

Chaddad-Neto

Dória-Netto

Filho

et al. 2014

Arq. Neuro-Psiquiatr.

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This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.Keywords: neurosurgery, craniotomy, microsurgery, far-lateral approach.RESUMO O presente artigo visa descrever de forma didática e prática a realização da craniotomia suboccipital extremo-lateral. Trata-se, portanto, de um texto fundamentalmente descritivo, dividido conforme as principais etapas da realização dessa craniotomia, e que descreve com detalhes a técnica com que o presente grupo de autores evolutivamente veio a realizá-la.Palavras-chave: neurocirurgia, craniotomia, extremo-lateral, microcirurgia.Approaching lesions located in the lower clivus and at the anterior edge of foramen magnum have always presented as a challenge to the neurosurgeon. The majority of these lesions have been approached posteriorly by suboccipital or retrosigmoid craniotomies and anteriorly by trans-oral and through the paranasal sinus approaches. Nevertheless all of then have disadvantages including a great depth of surgical field and an extremely limited lateral exposure 1 . Once the high morbidity and mortality of lesions located at so an important anatomic region, the improvement of these posterior approaches is imperative, in order to increase the surgical exposure and reduce the retraction of neurovascular structures.The far lateral approach is the one composed by the dissection of occipital-cervical muscles with the exposition of suboccipital triangle, the lateral suboccipital craniotomy and finally the exposure of vertebral artery since its entrance into the dura mater 2

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Cranial base approaches to posterior circulation aneurysms

Cited by 131 publications

References 27 publications

Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction

Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction

Petrosal approaches to posterior circulation aneurysms

The far-lateral craniotomy: tips and tricks

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