Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Department of Neurosurgery, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco.
Oper Neurosurg (Hagerstown). 2018 Nov 1;15(5):538-550. doi: 10.1093/ons/opx265.
The pterional approach, along with its orbitopterional and orbitozygomatic extensions, is among the most common surgical approaches for tackling challenging aneurysms of the basilar artery apex (BAX). There is general consensus that the orbitozygomatic approach provides the best exposure for these lesions. However, there is little objective evidence to support approach selection for surgical treatment of BAX aneurysms.
To compare different features regarding surgical treatment of BAX aneurysms between the pterional, orbitopterional, and orbitozygomatic approaches.
The pterional, orbitopterional, and orbitozygomatic approaches were sequentially completed on 10 cadaveric specimens. The visibility of perforators, lengths of exposure, and safe clipping for major BAX branches, surgical area of exposure, and the surgical freedom for the BAX target were assessed.
The orbitopterional approach provided significantly greater values than the pterional approach in all variables, except for exposure of the bilateral P1 posterior cerebral artery (PCA) perforators. When compared to the orbitopterional approach, the orbitozygomatic approach did not provide a statistically significant increase in (1) surgical freedom through the carotid-oculomotor triangle, (2) area of exposure, (3) ipsilateral, and (4) contralateral P1 PCA perforator visibility, and (5) ipsilateral PCA exposure and (6) clipping lengths.
The orbitopterional approach provides significantly greater surgical exposure to BAX than the pterional approach. The orbitopterional approach is less invasive while providing similar surgical access to the BAX compared to the orbitozygomatic. The results of this study show that the orbitopterional approach may be optimal for the treatment of most BAX aneurysms, particularly to reduce morbidity resulting from the full orbitozygomatic approach.
翼点入路及其眶翼入路和眶颧入路是处理基底动脉尖部（BAX）挑战性动脉瘤最常用的手术入路之一。普遍认为眶颧入路为这些病变提供了最佳显露。然而，对于选择哪种手术入路来治疗 BAX 动脉瘤，目前几乎没有客观证据支持。
比较翼点入路、眶翼入路和眶颧入路治疗 BAX 动脉瘤的不同特点。
对 10 具尸体标本依次完成翼点入路、眶翼入路和眶颧入路。评估穿支血管的显露、显露长度、主要 BAX 分支的安全夹闭、手术显露区域以及 BAX 目标的手术自由度。
眶翼入路在所有变量中的值均显著大于翼点入路，除双侧 P1 大脑后动脉（PCA）穿支血管的显露外。与眶翼入路相比，眶颧入路在（1）通过颈内-动眼神经三角的手术自由度、（2）显露面积、（3）同侧和（4）对侧 P1 PCA 穿支血管的显露、（5）同侧 PCA 的显露和（6）夹闭长度方面，并没有提供统计学上显著增加的优势。
眶翼入路为 BAX 提供了比翼点入路更显著的手术显露。与眶颧入路相比，眶翼入路的侵袭性更小，但为 BAX 提供了类似的手术入路。本研究结果表明，对于大多数 BAX 动脉瘤的治疗，眶翼入路可能是最佳选择，特别是为了降低全眶颧入路引起的发病率。
