Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of
- PDF / 160,308 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 76 Downloads / 140 Views
EDITORIAL (BY INVITATION) - VASCULAR NEUROSURGERY - OTHER
Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers. Timothy G White 1 & Giyarpuram N Prashant 1,2 & Prashin Unadkat 1 & Amir R Dehdashti 1 Received: 6 July 2020 / Accepted: 10 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
We commend the authors for their efforts to formalize an approach to basilar apex aneurysms. Key to the approach of any aneurysm is the establishment of proximal control as well as the ability to dissect and visualize the neck of the aneurysm to ensure appropriate clip placement, which can be particularly challenging in basilar aneurysms given its anatomic location and deep perforators. Given the variable anatomy of the basilar artery, numerous approaches and schema have been developed and described in the literature [1]. Historically, the pterional and subtemporal approaches were described to access the basilar apex; however, numerous other techniques have been developed to facilitate access to the basilar artery an d e xp an d th e s urg ica l c orri dor , in clu din g th e orbitozygomatic craniotomy, various transpetrosal approaches, and the endoscopic transclival approach [1–6]. This paper provides a systematic approach to classifying the surgical corridors and techniques that can be used to enhance access to the basilar artery from a frontotemporal approach. It describes access to the basilar artery through three common corridors: the opticocarotid (OCT), the carotid oculomotor (COT), and the oculo-tentorial (OTT). Baseline measurements of these surgical windows were calculated in cadaveric specimens after completing an orbitozygomatic craniotomy. Subsequently, specific maneuvers were used to expand access, including division of the carotid distal dural ring, opening of the oculomotor triangle, mobilization of the This article is part of the Topical Collection on Vascular Neurosurgery Other * Amir R Dehdashti [email protected] 1
Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
2
Department of Neurosurgery, University of California, Los Angeles, CA, USA
oculomotor nerve, and posterior clinoidectomy. Through this method, “normal” dimensions of each of these windows were compared before and after neurovascular mobilization. The included figures provide an excellent illustration of these methods and the exposure gained. While we appreciate the effort to study this approach and provide quantitative measurements of specific corridors, it is important to note that in many cases, the approach will be dictated largely by the patient’s individual anatomy and intraoperative findings. The surgical windows described in this manuscript must be explored intraoperatively to determine the optimal trajectory and often are used in tandem, for instance a basilar artery proximal control through OTT and aneurysm exposure through COT. The add
Data Loading...
