Nutik S L
Department of Neurosurgery, Kaiser Foundation Hospital, Redwood City, California 94063, USA.
J Neurosurg. 1998 Dec;89(6):921-6. doi: 10.3171/jns.1998.89.6.0921.
The author describes a surgical procedure in which pterional craniotomy is performed via a transcavernous approach to treat low-lying distal basilar artery (BA) aneurysm. This intradural procedure is compared with the extradural procedure described by Dolene, et al.
The addition of a transcavernous exposure to the standard pterional intradural transsylvian approach allows a lower exposure of the distal BA behind the dorsum sellae. The technical steps involved in this procedure are as follows: 1) removal of the anterior clinoid process: 2) entry into the cavernous sinus medial to the third nerve; 3) packing of the venous channels of the cavernous sinus lying between the carotid artery and the pituitary gland to open this space; 4) removal of the posterior clinoid process and the portion of the dorsum sellae that is exposed from within the cavernous sinus; and 5) removal of the exposed dura mater to obtain additional exposure of the peri-mesencephalic cistern. Eight cases of aneurysms of the distal BA are presented to illustrate how this approach can help in their surgical treatment.
Using the standard pterional approach, these distal BA aneurysms were found to be either too low relative to the posterior clinoid process for adequate exposure or there was insufficient room for temporary clipping of the BA proximal to the lesion. The addition of a transcavernous exposure eliminated these technical problems and aneurysm clipping could be accomplished in each case.
作者描述了一种手术方法，即通过经海绵窦入路进行翼点开颅术，以治疗低位基底动脉远端动脉瘤。将这种硬膜内手术与Dolene等人描述的硬膜外手术进行比较。
在标准的翼点硬膜内经侧裂入路基础上增加经海绵窦暴露，可在鞍背后方更低位置暴露基底动脉远端。该手术涉及的技术步骤如下：1）切除前床突；2）进入动眼神经内侧的海绵窦；3）填塞位于颈动脉和垂体之间的海绵窦静脉通道以打开该间隙；4）切除后床突及从海绵窦内暴露的鞍背部分；5）切除暴露的硬脑膜以进一步暴露中脑周围脑池。本文介绍了8例基底动脉远端动脉瘤病例，以说明该入路如何有助于其手术治疗。
采用标准翼点入路时，发现这些基底动脉远端动脉瘤相对于后床突位置过低，无法充分暴露，或者在病变近端暂时夹闭基底动脉的空间不足。增加经海绵窦暴露消除了这些技术问题，每例均成功完成了动脉瘤夹闭。
