Kim Young-Don, Elhadi Ali M, Mendes George A C, Maramreddy Naveen, Agrawal Abhishek, Kalb Samuel, Nakaji Peter, Spetzler Robert F, Preul Mark C
*Department of Neurological Surgery, Daegu Catholic University Medical Center, Daegu, South Korea; ‡Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Neurosurgery. 2015 Mar;11 Suppl 2:162-79; discussion 179-80. doi: 10.1227/NEU.0000000000000617.
The management of basilar apex (BX) aneurysms remains problematic.
We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA).
Eleven silicone-injected cadaveric heads were dissected bilaterally. The surgical dissection was divided into 4 major steps: (1) supraorbital modified orbitozygomatic craniotomy, (2) mobilization of the internal carotid artery after drilling out the anterior clinoid process intradurally and cutting the distal dural ring, (3) drilling out the posterior clinoid process and dorsum sellae, and (4) dividing the PCoA from the posterior third portion of the vessel. A frameless navigation system was used to quantify the surgical exposure area of the BX through the OCW and COW.
The total surgical area increased significantly from steps 1 to 4 (P < .001) in both OCW and COW groups. Overall, there was a larger total surgical area obtained in the COW compared with the OCW (P = .010). ICA mobilization increased the surgical area for temporary (P < .001) and permanent (P < .003) clip application in both windows. The division of PCoA significantly increased the overall surgical area for permanent clip application (P < .003). Compared with the OCW, the COW had a significantly increased change in the area for permanent clip application in the low-lying group (P = .03).
When approaching the BX via the pterion route, the appropriate surgical step and window should be selected according to characteristics of the PCoA and height of the BX.
基底动脉尖（BX）动脉瘤的治疗仍然存在问题。
我们对在解剖颈内动脉和切断后交通动脉（PCoA）前后，通过视颈动脉窗（OCW）和颈动脉动眼神经窗（COW）对BX的手术显露情况进行量化。
对11个注射了硅胶的尸体头部进行双侧解剖。手术解剖分为4个主要步骤：（1）眶上改良眶颧开颅术；（2）在硬膜内磨除前床突并切断远端硬膜环后游离颈内动脉；（3）磨除后床突和鞍背；（4）从血管的后三分之一部分切断PCoA。使用无框架导航系统通过OCW和COW对BX的手术显露面积进行量化。
在OCW和COW组中，从步骤1到步骤4，总手术面积均显著增加（P <.001）。总体而言，COW获得的总手术面积比OCW大（P =.010）。颈内动脉游离增加了两个窗口中临时夹闭（P <.001）和永久夹闭（P <.003）的手术面积。切断PCoA显著增加了永久夹闭的总体手术面积（P <.003）。与OCW相比，在低位组中，COW永久夹闭区域的面积变化显著增加（P =.03）。
经翼点入路处理BX时，应根据PCoA的特点和BX的高度选择合适的手术步骤和窗口。
