Abstract
Surgery for high placed basilar bifurcation aneurysm is one of the most difficult neurological operations. There are special approaches for high basilar bifurcation aneurysms such as the temporopolar approach, zygomatic approach, transzygomatic subtemporal approach, transclinoid transsellar transcavernous approach, and transthird ventricular approach. In this paper, we will discuss some technical procedures that we have developed for the transcrista galli translamina terminalis approach in treating a small high basilar bifurcation aneurysm.
Case report
A 73-year-old woman was referred with a diagnosis of SAH Grade IV, and pulmonary effusion. Cerebral angiograms and helical 3D CT demonstrated an aneurysm arising at the bifurcation of the basilar artery. The aneurysm measured 7mm×10mm and the neck of the aneurysm was located 15mm high from the posterior clinoid process. The transcrista galli, interfalcine, translamina terminalis approach was selected because of the patient's old age and the highly placed basilar bifurcation aneurysm in the third ventricle. This approach requires less brain retraction. We will discuss some tactics of approaching this aneurysm, clipping techniques, and the surgical merits and demerits of this approach.
