Surgical approaches for vertebro-basilar trunk aneurysms located in the midline

Abstract

Fourteen cases of midline vertebro-basilar trunk aneurysms were operated on by four routes of surgical approach: middle fossa anterior transpetrosal approach (ATP), presigmoid transpetrosal approach (PTP), conventional lateral suboccipital approach (LSO) or suboccipital transcondylar approach (STC). There was no mortality, but the morbidity was different depending on the surgical approach. In basilar trunk aneurysms located higher than the internal auditory canal, excellent results were obtainable by ATP, especially in the case of posteriorly projecting aneurysms. For midline vertebral aneurysms located lower than the internal auditory canal, STC resulted in less surgical complications than LSO. Extradural resection of the jugular tubercle was necessary for aneurysms located on the distal vertebral artery at or close to the vertebro-basilar junction. For vertebro-basilar junction aneurysms located at the level of the internal auditory canal, hearing was preserved by STC, but not by ATP or PTP. However, choice of the surgical approach may depend on the direction of the aneurysm and the technical accessibility of the skull base. All these skull base approaches reduced surgical complications of retraction damage to the cranial nerves and the brain stem. This holds true for all aneurysms arising from the midline vertebro-basilar trunk.

Ruptured Dissecting Anterior Inferior Cerebellar Artery Aneurysm. Case Report.

“…2,6) difficult because of the deep location and adhesion to cranial nerves such as the seventh and the eighth cranial nerves. In our case, the aneurysm was more difficult to approach because of the location on the proximal AICA.…”

Petrosal approaches to posterior circulation aneurysms

“…4,23,[28][29][30][31]37,38,56,59 This table provides historical perspective on the application of this approach, spanning 3 decades, as some reports are inclusive of earlier reports from the 1980s. 4,30,31 Aneurysm remnants were reported in 3 cases (11%) after treatment. Early morbidity was reported in 18 cases (67%).…”

“…There was 1 case (4%) of permanent hearing loss attributed to excessive petrous bone resection in an effort to expose a vertebrobasilar junction aneurysm. 30 …”

“…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. …”

Assessment of Cognitive Function Before and After Surgery for Posterior Cranial Fossa Lesions Using Computerized and Conventional Tests

“…The development of skull base surgery in the last two decades now allows good surgical results for skull base lesions. 21,22,39) Recent clinical, experimental, and neuroimaging studies have indicated that the cerebellum is involved in various neural processes of the higher brain functions such as language, working memory, executive function, and emotion. [2][3][4]7,12,17,18,25,33,34,37,40) Therefore, both neurological status and higher brain function must be maintained after skull base surgery.…”