| Autor: |
Abdel Aziz, Khaled M., Andaluz, Norberto, Zuccarello, Mario |
| Zdroj: |
Neurosurgery Quarterly; Jun2007, Vol. 17 Issue 2, p101-112, 12p |
| Abstrakt: |
The surgical treatment of aneurysms of the basilar bifurcation remains one of the ultimate challenges in vascular neurosurgery, carrying the highest surgical morbidity and mortality among all aneurysms. Understanding of the anatomy of the aneurysm and the surrounding structures is mandatory to select the optimal surgical approach. The authors have adopted a system defined by clival zones, on the basis of the relationships of the basilar artery and the aneurysmal neck with the clivus, to determine the most suitable surgical approach. The region above the posterior clinoid process (PCP) is zone 0, within 10 mm of the PCP is zone 0a, and more than 10 mm above the PCP is zone 0b. These aneurysms are best approached by means of the pterional approach and its variants. Clival zone I extends between the PCP and the floor of the internal auditory canal, zone Ia is located between the PCP and the floor of the sella, and zone Ib is located from the sellar floor to the internal auditory canal. Aneurysms of zone Ia are best approached through the subtemporal approach and of zone Ib through the anterior transpetrosal (Kawase) approach. The approaches are combined with recent skull base techniques to minimize the disadvantages of the classic approaches. Zone II (located 18-24 mm below the sellar floor) and zone III (lower clival zone) are defined, but almost all basilar bifurcation aneurysms will be located at clival zone I and above. The authors believe that these principles are valuable to aid in the selection of a surgical approach to effectively treat basilar bifurcation aneurysms. [ABSTRACT FROM AUTHOR] |
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