Article
Proximal control of the basilar artery during the subtemporal approach for surgery in the high basilar region – anatomical comparison in cadaveric dissections and retrospective clinical case series
Proximale Kontrolle der Arteria basilaris während des subtemporalen Zugangs zur Basilarisregion – Anatomischer Vergleich bei Kadaverdissektionen und retrospektive klinische Fallserie
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Authors
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Eleftherios Archavlis
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Lucas Serrano
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
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Sven Rainer Kantelhardt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region and to evaluate visibility, operability of all anatomic structures as well as proximal control of the basilar artery.
Methods: 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach.
Results: In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral-, superior cerebellar and perforant arteries as well as surgical working area in the basilar tip provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the 4rth cranial nerve (both p<0.001). Concerning proximal control of the high basilar segment, tentorial incision provided a significant advantage for placement of a proximal temporal clip (groups A versus B, p<0.05) but clipping of the high basilar segment was also feasible using a tentorial tethering only in cases where proximal control is not required.
Conclusion: For a subtemporal approach to the high basilar aneurysms the tentorial incision creates a dural flap and provides an additional objectified advantage for placement of a proximal temporary clip when the pathology requires proximal control. The rather less invasive and less time consuming tentorial retraction could be an option in selected cases where proximal control and temporal clipping is not required in order to perform safe treatment.
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