Seoane E, Tedeschi H, de Oliveira E, Wen H T, Rhoton A L
Department of Neurosurgery, University of Florida, Gainesville, USA.
Neurosurgery. 2000 Apr;46(4):891-8; discussion 898-9. doi: 10.1097/00006123-200004000-00021.
To illustrate in a stepwise fashion the microsurgical anatomy of the transcavernous approach to the interpeduncular and prepontine cisterns and to discuss our initial results with 15 basilar tip aneurysms managed through that approach.
Using 10 embalmed cadaveric heads perfused with colored silicon, we performed bilateral stepwise dissections of the transcavernous approach via an orbitozygomatic pretemporal craniotomy. Measurements of the exposure of the basilar artery obtained along the dorsum sellae and upper clivus were taken. Our clinical data were derived from a series of 15 patients with large basilar tip aneurysms treated surgically via the transcavernous approach between 1997 and 1999. Indications for surgery were based on the size of the aneurysm (all were large) and its position in relation to the dorsum sellae (eight were more than 5 mm below the level of the dorsum sellae).
Good exposure of the neurovascular structures of the interpeduncular and prepontine cisterns (namely, the basilar artery) was obtained in all cases as compared with other well-established approaches to the area. All patients in our surgical series did well except that all incurred an expected third nerve palsy, caused by surgical manipulation, which resolved over the course of 2 weeks to 3 months.
Although technically difficult, the transcavernous approach provides better exposure of the interpeduncular and prepontine cisterns relative to that afforded by other, more conventional approaches. The satisfactory results obtained in our preliminary series of patients greatly support the use of this approach for complex basilar tip aneurysms.
以逐步的方式阐述经海绵窦入路至脚间池和脑桥前池的显微外科解剖，并讨论我们采用该入路治疗15例基底动脉尖部动脉瘤的初步结果。
使用10个经彩色硅灌注的防腐尸头，通过眶颧颞下入路对经海绵窦入路进行双侧逐步解剖。测量沿鞍背和上斜坡获得的基底动脉暴露情况。我们的临床数据来自1997年至1999年间通过经海绵窦入路手术治疗的一系列15例大型基底动脉尖部动脉瘤患者。手术指征基于动脉瘤的大小（均为大型）及其相对于鞍背的位置（8例位于鞍背水平以下5mm以上）。
与该区域其他成熟的入路相比，所有病例均能很好地暴露脚间池和脑桥前池的神经血管结构（即基底动脉）。我们手术系列中的所有患者情况良好，只是均因手术操作导致预期的动眼神经麻痹，在2周至3个月内恢复。
尽管技术难度较大，但经海绵窦入路相对于其他更传统的入路，能更好地暴露脚间池和脑桥前池。我们初步系列患者取得的满意结果有力支持了该入路用于治疗复杂的基底动脉尖部动脉瘤。
