分析基底动脉分叉部手术自由度的变化：深入了解基底动脉顶端动脉瘤入路选择。

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.

Skull Base and Cerebrovascular Laboratory, University of California, San Francisco.

Oper Neurosurg (Hagerstown). 2018 Dec 1;15(6):692-700. doi: 10.1093/ons/opy012.

BACKGROUND

The orbitozygomatic approach is generally advocated over the pterional approach for basilar apex aneurysms. However, the impact of the extensions of the pterional approach on the obtained maneuverability over multiple vascular targets (relevant to basilar apex surgery) has not been studied before.

OBJECTIVE

To analyze the patterns of surgical freedom change across the basilar bifurcation between the pterional, orbitopterional, and orbitozygomatic approaches.

METHODS

Surgical freedom was assessed for 3 vascular targets important in basilar apex aneurysm surgery (ipsilateral and contralateral P1-P2 junctions, and basilar apex), and compared between the pterional, orbitopterional, and orbitozygomatic approaches in 10 cadaveric specimens.

RESULTS

Transitioning from the pterional to orbitopterional approach, the surgical freedom increased significantly at all 3 targets (P < .05). However, the gain in surgical freedom declined progressively from the most superficial target (60% for ipsilateral P1-P2 junction) to the deepest target (35% for contralateral P1-P2 junction). Conversely, transitioning from the orbitopterional to the orbitozygomatic approach, the gain in surgical freedom was minimal for the ipsilateral P1-P2 and basilar apex (<4%), but increased dramatically to 19% at the contralateral P1-P2 junction.

CONCLUSION

The orbitopterional approach provides a remarkable increase in surgical maneuverability compared to the pterional approach for the basilar apex target and the relevant adjacent arterial targets. However, compared to the orbitopterional, the orbitozygomatic approach adds little maneuverability except for the deepest target (ie, contralateral P1-P2 junction). Therefore, the orbitozygomatic approach may be most efficacious with larger basilar apex aneurysms limiting the control over of the contralateral P1 PCA.

背景

眶颧入路通常优于翼点入路用于基底尖动脉瘤。然而，翼点入路的扩展对多个血管目标（与基底尖手术相关）的可操作性的影响之前尚未研究过。

目的

分析翼点入路、眶颧入路和眶颧入路在基底分叉处穿过基底尖的手术自由度变化模式。

方法

在 10 个尸体标本中，评估了 3 个对基底尖动脉瘤手术重要的血管目标（同侧和对侧 P1-P2 交界处和基底尖）的手术自由度，并将翼点入路、眶颧入路和眶颧入路进行比较。

结果

从翼点入路到眶颧入路，所有 3 个目标的手术自由度显著增加（P<.05）。然而，手术自由度的增益从最浅的目标（同侧 P1-P2 交界处的 60%）到最深的目标（对侧 P1-P2 交界处的 35%）逐渐下降。相反，从眶颧入路到眶颧入路，同侧 P1-P2 和基底尖的手术自由度增益最小（<4%），但在对侧 P1-P2 交界处增加了 19%。