Samson D S, Hodosh R M, Clark W K
Neurosurgery. 1978 Sep-Oct;3(2):135-41. doi: 10.1227/00006123-197809000-00001.
The microsurgical correlates the pterional approach to the distal basilar circulation were evaluated in 20 cases of posterior circulation aneurysms, 50 human cadaver dissections, and a variety of other intracranial surgical lesions. The pterional approach permitted successful clipping of the aneurysm in 13 of 15 basilar bifurcation aneurysms, 1 of 2 basilar-posterior cerebral aneurysms, and 2 of 3 basilar-superior cerebellar aneurysms. In each of the failed attempts via the pterional approach, the subtemporal route ultimately resulted in proper clip application. The interposition of the posterior clinoid process was the impediment to successful clipping in three of the four cases that could not be managed via the pterional approach. All 3 of these patients had a basilar bifurcation that was below the level of the posterior clinoid on angiography, whereas none of the remaining 17 aneurysm patients demonstrated a low-lying bifurcation. Posterior displacement of the basilar artery away from the posterior clinoid exceeded 1 cm in only 13% of our cases and was not an impediment to successful clipping of the aneurysm via the pterional route. We conclude that, when the anatomical situation is appropriate, the pterional approach offers the advantages of less brain retraction and better visualization of the parent arteries and important perforating branches when compared to the subtemporal approach.
对20例后循环动脉瘤、50例人体尸体解剖以及各种其他颅内手术病变进行了翼点入路与基底动脉远端循环的显微外科相关性评估。翼点入路成功夹闭了15例基底动脉分叉动脉瘤中的13例、2例基底动脉-大脑后动脉瘤中的1例以及3例基底动脉-小脑上动脉瘤中的2例。在通过翼点入路的每一次失败尝试中，颞下途径最终成功夹闭动脉瘤。在4例无法通过翼点入路处理的病例中，有3例是后床突的阻挡妨碍了成功夹闭。这3例患者的基底动脉分叉在血管造影上均低于后床突水平，而其余17例动脉瘤患者均未显示低位分叉。仅13%的病例基底动脉向后移位超过1 cm，且这并非通过翼点入路成功夹闭动脉瘤的障碍。我们得出结论，当解剖情况合适时，与颞下入路相比，翼点入路具有脑牵拉较少、能更好地显露载瘤动脉和重要穿支的优点。
