Abstract
Skull base approaches allow direct, short, and multidirectional access to the aneurysms located near the base of the skull with minimal retraction of the brain and the vessels.
We describe surgical experience of skull base approaches performed in 48 patients with cerebral aneurysms. They consisted of 7 males and 41 females, and ranged in age from 20 to 77 years old with the average of 55. They included 31 aneurysms of the paraclinoid internal carotid artery, 4 of the anterior communicating artery, 9 of the distal basilar artery, and 4 of the vertebral-posterior inferior cerebellar artery.
Intradural or extradural unroofing of the optic canal and removal of the anterior clinoid process were accomplished in addition to the fronto-temporal craniotomy in surgery of aneurysms of the paraclinoid internal carotid artery. When the aneurysm was large or giant, the aneurysm was collapsed to successfully obliterate the aneurysmal neck by combined use of the trapping-evacuation technique. The rim and roof of the orbit were removed as deeply as possible, resulting in very short and direct access to the aneurysms of the anterior communicating artery without significant brain retraction.
For cases with distal basilar artery aneurysm, the fronto-orbito-zygomatic was applied. When the aneurysm was situated in a low position, the posterior clinoid process, dorsum sellae, or the upper part of the clivus were removed to expose the aneurysm and the proximal segment of the basilar artery. In case of the aneurysm located at the union of the vertebral artery or the vertebral-posterior inferior cerebellar artery bifurcation, the transcondylar approach was used to fully expose the aneurysms and the proximal and distal segment of the vertebral arteries.
Application of the skull base approaches in aneurysmal surgery resulted in an acceptable morbidity and mortality.
In conclusion, skull base approaches were safe and useful to treat some patients with cerebral aneurysm, which were considered to be difficult to reach by conventional approaches. Various approaches of skull base surgery provided the maximally effective surgery in treating patients with cerebral aneurysm with minimal invasion.
