Anatomical and quantitative description of the transcavernous approach to interpeduncular and prepontine cisterns

Document Type

Article

Abstract

Object. The management of wide-necked, giant, or unsuccessfully coil-treated basilar apex aneurysms requires a wide exposure, for both working area and linear visualization of the basilar artery (BA). Cranial-based approaches, such as the transcavernous approach, have been proposed to deal with such aneurysms; whether abbreviated forms of this approach might provide similar exposure remains controversial. The authors examine this issue quantitatively. Methods. Four alcohol-preserved cadaveric heads injected with pigmented silicone were prepared for bilateral dissection. After completing an orbitozygomatic craniotomy, the surgeons worked in a reverse direction, performing the transcavernous approach in five steps: 1) posterior clinoidectomy; 2) cavernous sinus opening; 3) anterior clinoidectomy; 4) cutting of the distal dural ring; and 5) cutting of the proximal dural ring. Performing the complete transcavernous approach significantly increased the working area and linear exposure of the BA compared with abbreviated forms of the approach (p < 0.05). Opening the roof of the cavernous sinus significantly increased the working area compared with posterior clinoidectomy alone (p = 0.014); however, additional gains in exposure required completing the transcavernous approach. Resection of the anterior clinoid process combined with opening of only the distal dural ring did not significantly increase the working area or linear exposure of the BA. Conclusions. The complete transcavernous approach significantly increases the working area and linear exposure of the BA compared with the more conservative forms of approach.

Keywords

Basilar artery, Cavernous sinus, Microsurgery, Quantitative study, Transcavernous approach

Publication Date

6-1-2006

Publication Title

Journal of Neurosurgery

ISSN

00223085

E-ISSN

00223085

Volume

104

Issue

6

First Page

957

Last Page

964

PubMed ID

16776341

Digital Object Identifier (DOI)

10.3171/jns.2006.104.6.957

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