Fronto-temporo-orbitozygomatic craniotomy and "half-and-half" approach for basilar apex aneurysms

Abstract

This simple approach provides a wide surgical corridor from 5 mm below to greater than 1 cm above dorsum sellae with adequate proximal control of basilar artery. It is an option to endovascular embolization especially with large and giant, or wide-necked BAA, vertebrobasilar tortuosity, coil compaction or postcoiling re-rupture and an associated large haematoma.

Microsurgical management of posterior cerebral artery aneurysms: A report of thirty cases in modern era

“…21,22 Advantages of this approach include increased visual angle, reduced tension to the brain, and reduced surgical operating depth. Using this approach, the top of the bilateral PCA and the basilar artery can be observed in the surgical field.…”

Endoscopic anatomy of the intracisternal oculomotor nerve: a new segmentation based on the topography of the arachnoid membranes

“…Pathologies are rare in this region. Posteriorly projected basilar apex aneurysms could be attached to the membranes which are hidden by the aneurysm from supraorbital subfrontal direction [2,19].…”

“Modified Half Tran-Sylvian and Half Subtemporal Approach” for Microsurgical Clipping of Posterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video

“…The technical considerations and literature on treatment outcomes for the "half and half" approach are reviewed. [9][10][11][12][13][14][15][16][17][18][19][20] This surgical video reviews the microsurgical anatomy, technical pearls, and clinical course with preoperative and postoperative imaging for microsurgical clipping of a ruptured PCA aneurysm. Informed consent was obtained from the patient and family for the surgery, and verbal consent was obtained for the publication of the case and its associated imaging.…”