Microsurgical anatomy of approaches and perforating arteries in the surgery of the basilar artery aneurysm were examined under the operating microscope using 51 cadaveric brains (102 cerebral hemispheres). The operative approaches studied were as follows: 1. Lateral retrocarotid approach, which was via the lateral retrocarotid space (LRCS) located between the posterior communicating artery and the oculomotor nerve. [Lateral to the posterior communicating artery]. 2. Medial retrocarotid approach, which passed through the route between the perforating branches of the posterior communicating artery via the medial retrocarotid space (MRCS) located between the posterior communicating and the internal carotid arteries. [Medial to the posterior communicating artery] 3. The opticocarotid approach was via the opticocarotid space (OCS) located between the optic nerve and the internal carotid artery.
The histories of 25 of our own patients, operated on in the past three years, (1987-1989) were also reviewed with special reference to the approaches. Favorable outcome (excellent 14, good 4, fair 3) was obtained in 21 cases (84%). Unfavorable outcome, found in 4 cases (poor 2, death 2), was due to the occlusion of the arteries, including perforating branches, and was not related to the difference of the various approaches.
Preservation of the perforators is important and avoids the morbidity and mortality due to surgical procedure in this region, leading to successful results.
