Skull base approaches to complex cerebral aneurysms

Origitano, Thomas C.; Anderson, Douglas E.; Tarassoli, Yahgoub; Reichman, Orna; Al‐Mefty, Ossama

doi:10.1016/0090-3019(93)90148-t

Cited by 52 publications

(20 citation statements)

References 35 publications

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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%

“…4 In the context of posterior circulation aneurysms, such an approach affords better proximal exposure and control along the basilar trunk. 43 Capitalizing 31 (study published in 1985) and data that Kawase subsequently provided for Aziz et al 4 (study published in 1999).…”

Section: Posterior Petrosal Approachmentioning

confidence: 99%

“…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. …”

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confidence: 99%

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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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Section: Posterior Petrosal Approachmentioning

confidence: 90%

Section: Posterior Petrosal Approachmentioning

confidence: 99%

mentioning

confidence: 99%

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Petrosal approaches to posterior circulation aneurysms

Gross

Tavanaiepour²,

Du³

et al. 2012

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“…This presigmoid, retrolabyrinthine approach has served as the backbone in the approach to innumerable neoplastic and vascular lesions over the past 3 decades. [1][2][3]9,27,28,30,31,33,34,36 The Posterior Petrosal Approach…”

Section: Evolution To the Modern Posterior Petrosal Approachmentioning

confidence: 99%

“…[1][2][3]9,13,27,28,30,31,33,34,36 At the mere expense of meticulous bone work to preserve the labyrinth and skeletonize the sigmoid sinus, this approach affords a wide exposure, minimizing operative distance and brain retraction, and affording multiple working angles to the neurosurgical target and adjacent vascular anatomy. [1][2][3]9,13 These advantages are only fully realized by the division of the tentorium and superior petrosal sinus and mobilization of a completely skeletonized sigmoid sinus.…”

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Evolution of the posterior petrosal approach

Gross¹,

Tavanaiepour²,

Du³

et al. 2012

FOC

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In this article, the authors review the history of the posterior petrosal approach. The early foundation of the retrolabyrinthine lateral petrosectomy has its roots in the otolaryngology literature. These early approaches were limited in exposure by the tentorium superiorly and the sigmoid sinus posteriorly. Although the concept of a transtentorial approach was originally combined with a complete labyrinthectomy, Hakuba and colleagues described the expansive exposure afforded by sectioning the tentorium and superior petrosal sinus and mobilizing a skeletonized sigmoid sinus. This maneuver serves as the key step in allowing for the full, combined supra- and infratentorial exposure that the posterior petrosal approach provides. In contrast to Hakuba et al.'s approach, which used a partial labyrinthectomy, modern approaches often preserve the entire labyrinth (retrolabyrinthine approach). For added exposure, the latter can be combined with the anterior petrosal approach, allowing for the preservation of hearing and an enhanced view of the surgical target. The authors review the evolution of the petrosal approach and highlight its applicability.

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Arterial relationships to the nerves and some rigid structures in the posterior cranial fossa

Surchev

2008

Clinical Anatomy

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The close relationships between the cranial nerves and the arterial vessels in the posterior cranial fossa are one of the predisposing factors for artery-nerve compression. The aim of this study was to examine the relationships of the vertebral and basilar arteries to some skull and dural structures and the nerves in the posterior cranial fossa. For this purpose, the skull bases and brains of 70 cadavers were studied. The topographic relationships of the vertebral and basilar arteries to the cranial nerves in the posterior cranial fossa were studied and the distances between the arteries and some osseous formations were measured. The most significant variations in arterial position were registered in the lower half of the basilar artery. Direct contact with an artery was established for the hypoglossal canal, jugular tubercle, and jugular foramen. The results reveal additional information about the relationships of the nerves and arteries to the skull and dural formations in the posterior cranial fossa. New quantitative information is given to illustrate them. The conditions for possible artery-nerve compression due to arterial dislocation are discussed and two groups (lines) of compression points are suggested. The medial line comprises of the brain stem points, usually the nerve root entry/exit zone. The lateral line includes the skull eminences, on which the nerves lie, or skull and dural foramina through which they exit the cranial cavity.

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Skull base approaches to complex cerebral aneurysms

Cited by 52 publications

References 35 publications

Petrosal approaches to posterior circulation aneurysms

Petrosal approaches to posterior circulation aneurysms

Evolution of the posterior petrosal approach

Arterial relationships to the nerves and some rigid structures in the posterior cranial fossa

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