CRANIAL BASE APPROACHES TO INTRACRANIAL ANEURYSMS IN THE SUBARACHNOIDSPACE

THE USE OF cranial base approaches to aneurysm surgery is illustrated by means of patient examples. Over a 9-year period, cranial base appro aches were used to expose and treat 38 aneurysms involving the anterio r communicating artery complex, proximal internal carotid artery, basi lar artery, or vertebral artery. The approaches included orbital osteo tomy, orbitozygomatic osteotomy, petrous apicectomy, presigmoid petros ectomy, and extreme lateral transcondylar methods. Complications relat ed to the approaches included one partial ptosis and two cerebrospinal fluid leaks, which resolved with treatment. The technique of three-di mensional computed tomographic angiography was useful in delineating t he vascular anatomy and its relation to the cranial base structures. T his helped the surgeon plan the appropriate approach to the aneurysm. Cranial base approaches, used selectively, can provide improved exposu re of deep-seated aneurysms and large or giant aneurysms, while minimi zing brain retraction.