Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Tailoring the surgical corridor to the basilar apex in the pretemporal transcavernous approach: morphometric analyses of different neurovascular mobilization maneuvers Xiaochun Zhao 1 & Mohamed A. Labib 1 & Kurt V. Shaffer 1 & Leandro Borba Moreira 1 & Dinesh Ramanathan 2 & Komal Naeem 1 & Evgenii Belykh 1 & Michael T. Lawton 1 & Miguel A. Lopez-Gonzalez 2 & Mark C. Preul 1 Received: 13 February 2020 / Accepted: 10 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
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. Keywords Basilar artery . Cavernous sinus
Abbreviations ACP Anterior clinoid process BA Basilar artery CC Carotid collar CN Cranial nerve CN II Optic nerve This article is part of the Topical Collection on Vascular Neurosurgery Other
CN III CN IV COT CTA ICA OCT OTT OZ PComA PTA
Oculomotor nerve Trochlear nerve Carotid-oculomotor triangle Computed tomography angiography Internal carotid artery Opticocarotid triangle Oculomotor-tentorial triangle Orbitozygomatic Posterior communicating artery Pretemporal approach
* Mark C. Preul [email protected] 1
2
The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ 85013, USA Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
Introduction Accessing the basilar artery (BA) via a pretemporal transcavernous approach (PTA) is an
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