The Interlenticulostriate Approach to Very High-Riding Distal Basilar Trunk Aneurysms

Operative Neurosurgery
Ralph RahmeMario Zuccarello

Abstract

Most high-riding distal basilar trunk aneurysms can be surgically approached via the transsylvian route and its orbitozygomatic variant. However, on rare occasions, the basilar bifurcation may be unusually high and an approach above the carotid terminus may be required. In this cadaveric study, we sought to determine the feasibility and exposure limits of the interlenticulostriate approach (ILSA). A standard transsylvian approach was performed in 10 cerebral hemispheres of 5 formalin-fixed, silicone-injected cadaver heads. The interpeduncular cistern was exposed via the opticocarotid window, carotid-oculomotor window, and supracarotid ILSA window. The latter was measured and an aneurysm clip or ventriculostomy stylet was placed as high as possible through each corridor. Using noncontrast 3-D rotational angiography, clip/stylet positions were measured relative to the dorsum sellae. ILSA provided a 9.4 × 4.6 mm mean surgical corridor, just enough room for a standard clip applier. This space was limited by the carotid bifurcation inferiorly, the lenticulostriate arteries medially and laterally, and the optic tract superiorly. There was no difference between opticocarotid and carotid-oculomotor windows, in terms of clip position (+...Continue Reading

References

Sep 1, 1992·Neurosurgery·R A de los ReyesM A Spatola
Jan 8, 2000·Stroke; a Journal of Cerebral Circulation·T E LempertR T Higashida
Dec 31, 2005·Journal of Neurosurgery·Hans HenkesDietmar Kühne
Oct 20, 2009·Journal of Neurosurgery·Erik Friedrich HauckDuke Samson

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