THE EFFECT OF ORBITOZYGOMATIC ACCESS FOR RUPTURED BASILAR AND RELATEDANEURYSMS ON MANAGEMENT OUTCOME

BACKGROUND Despite increasing use of craniofacial access for complex i ntracranial and skull base pathology, there have been no reports detai ling the impact of improved access on clinical outcome. METHODS Orbito zygomatic access was used in 32 patients with an aneurysm of the basil ar bifurcation, superior cerebellar, or posterior cerebral arteries ov er a 9-year period. RESULTS Operative mortality was 0%, overall manage ment mortality 9% and management morbidity was 9%. This approach was s elected for these patients because of the anatomy of the aneurysm and its relationship to the terminal basilar complex and the dorsum sellae /posterior clinoid process. The flexibility achieved by the access all owed intraoperative use of multiple corridors of access. Morbidity dir ectly attributable to the use of orbitozygomatic access was minimal. C ONCLUSIONS While management outcome after aneurysmal subarachnoid hemo rrhage relates directly to the severity of the initial hemorrhage, rat her than the surgical approach chosen, in selected patients we recomme nd the use of this approach as a valuable adjunct to the armamentarium of the vascular neurosurgeon. (C) 1997 by Elsevier Science Inc.