Petrosal Approaches for Intracranial Aneurysm

Choi, Chang Hwa

Abstract

Aneurysms of the vertebrobasilar trunk pose a most difficult anatomic problem to access because these lesions are located in a small restricted area encased with thick dense bone, with a limited subarachnoid space, and are filled with the most dense collection of vital cranial nerves and vascular structures. So, "exposure is everything" is very appropriate for these lesion. Furthermore, while achieving maximum exposure, there must be a minimum of brain retraction to protect the patient from the injury. For achieve these purpose, several techniques that maximize lateral skull removal to provide a relatively short and flat route of access to the front of the brain stem and basilar artery, were introduced but full satisfaction was not achieved. Recently, transpetrosal approaches were applied to access into the anterior brain stem and clival region through the petrosal bone removal without brain or brain stem retraction and excellent results were reported. In this paper, detailed summary of steps of each petrosal approaches and illustrations form Fukushima's manual of skull base dissection will be presented after reviewing some articles about petrosal approaches.