• Tayebi Meybodi Ali A Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA., Arnau Benet, Rodriguez Rubio Roberto R Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, USA., Sonia Yousef, Pooneh Mokhtari, Mark C Preul, and Michael T Lawton.
• Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
• World Neurosurg. 2018 Nov 1; 119: e607-e616.

BackgroundThe subtemporal and orbitozygomatic approaches are the most commonly used surgical approaches for the treatment of basilar artery apex (BAX) aneurysms. Relative advantages and disadvantages are generally reported based on surgeons' experience. This study was performed to provide a detailed comparison between the subtemporal and orbitozygomatic approaches based on cadaveric dissection analysis for the treatment of BAX aneurysms.MethodsSubtemporal and orbitozygomatic approaches were performed on 5 cadaveric heads (10 sides), and the following variables were assessed and compared between the 2 approaches: 1) number of exposed perforators on P1-posterior cerebral arteries (PCA); 2) lengths of exposure and clipping for bilateral PCA, superior cerebellar arteries (SCA), and basilar trunk; 3) surgical area of exposure; and 4) surgical freedom at the BAX.ResultsNumber of perforators exposed on P1-PCA was not different between the subtemporal and orbitozygomatic approaches. Exposure and clipping of ipsilateral SCA and PCA were superior using the subtemporal approach, and better for contralateral SCA and PCA using the orbitozygomatic approach, all reaching statistical significance. The orbitozygomatic approach provided greater exposure and clipping length for the proximal basilar trunk. Although the surgical area of exposure was similar between the 2 approaches, the overall surgical freedom was greater in the orbitozygomatic approach.ConclusionsThe orbitozygomatic approach provides a greater number of surgical corridors to the BAX and is superior regarding multiple surgically relevant anatomic parameters. Importantly, control over the basilar trunk and over the contralateral SCA and PCA (blind spots) is superior with the orbitozygomatic approach.Copyright © 2018 Elsevier Inc. All rights reserved.

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