Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers

Authors

Xiaochun Zhao, Barrow Neurological InstituteFollow
Mohamed A. Labib, Barrow Neurological InstituteFollow
Kurt V. Shaffer, Barrow Neurological Institute
Leandro Borba Moreira, Barrow Neurological Institute
Dinesh Ramanathan, Loma Linda University School of Medicine
Komal Naeem, Barrow Neurological Institute
Evgenii Belykh, Barrow Neurological InstituteFollow
Michael T. Lawton, Barrow Neurological InstituteFollow
Miguel A. Lopez-Gonzalez, Loma Linda University School of Medicine
Mark C. Preul, Barrow Neurological InstituteFollow

Document Type

Article

Abstract

Background: The pretemporal transcavernous approach (PTA) provides optimal exposure and access to the basilar artery (BA); however, the PTA can be invasive when vital neurovascular structures are mobilized. The goal of this study was to evaluate mobilization strategies to tailor approaches to the BA. Methods: After an orbitozygomatic craniotomy, 10 sides of 5 cadaveric heads were used to assess the surgical access to the BA via the opticocarotid triangle (OCT), carotid-oculomotor triangle (COT), and oculomotor-tentorial triangle (OTT). Measurements were obtained, and morphometric analyses were performed for natural neurovascular positions and after each stepwise expansion maneuver. An imaginary line connecting the midpoints of the limbus sphenoidale and dorsum sellae was used as a reference to normalize the measurements of BA exposure and to facilitate the clinical applicability of this technique. Results: In the OCT, the exposed BA segment ranged from − 1 ± 3.9 to + 6 ± 2.0 mm in length in its natural position. In the COT, the accessible BA segment ranged from − 4 ± 2.3 to − 2 ± 3.0 mm in length in its natural position. Via the OTT, the accessible BA segment ranged from − 7 ± 2.6 to − 5 ± 2.8 mm in length in its natural position. In the OCT, COT, and OTT, a posterior clinoidectomy extended the exposure down to − 6 ± 2.7, − 8 ± 2.5, and − 9 ± 2.9 mm, respectively. Conclusions: This study quantitatively evaluated the need for the expansion maneuvers in the PTA to reach BA aneurysms according to the patient’s anatomical characteristics.

Publication Date

11-1-2020

Publication Title

Acta Neurochirurgica

ISSN

00016268

E-ISSN

09420940

Volume

162

Issue

11

First Page

2731

Last Page

2741

PubMed ID

32757048

Digital Object Identifier (DOI)

10.1007/s00701-020-04490-8

Recommended Citation

Zhao, Xiaochun; Labib, Mohamed A.; Shaffer, Kurt V.; Moreira, Leandro Borba; Ramanathan, Dinesh; Naeem, Komal; Belykh, Evgenii; Lawton, Michael T.; Lopez-Gonzalez, Miguel A.; and Preul, Mark C., "Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers" (2020). Neurosurgery. 1384.
https://scholar.barrowneuro.org/neurosurgery/1384