Abstract
The basic craniotomies used for obliterating an intracranial aneurysm are essential surgical techniques in the arsenal acquired through the career of a training neurosurgeon. The array of treatment options is an ever-evolving field, and neurosurgeons must understand the essential anatomical principles and develop a step-wise approach in selecting a specific surgical corridor for when an open surgical procedure is needed. This chapter provides a descriptive review of the primary surgical approaches used to access and obliterate aneurysms within the intracranial vasculature, as well as insight into the selection process of each surgical window and its benefits and inherent limitations. We discuss the main craniotomies involved in the treatment of intracranial aneurysms arising from both the anterior and posterior circulation.
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References
Wong JH, Tymianski R, Radovanovic I, Tymianski M. Minimally invasive microsurgery for cerebral aneurysms. Stroke. 2015;46(9):2699–706.
Fischer G, Stadie A, Reisch R, Hopf NJ, Fries G, Bocher-Schwarz H, et al. The keyhole concept in aneurysm surgery: results of the past 20 years. Neurosurgery. 2011;68(1 Suppl Operative):45–51; discussion.
Radovanovic I, Abou-Hamden A, Bacigaluppi S, Tymianski M. A safety, length of stay, and cost analysis of minimally invasive microsurgery for anterior circulation aneurysms. Acta Neurochir. 2014;156(3):493–503.
Yasargil MG, Fox JL. The microsurgical approach to intracranial aneurysms. Surg Neurol. 1975;3(1):7–14.
Figueiredo EG, Deshmukh P, Nakaji P, Crusius MU, Crawford N, Spetzler RF, et al. The minipterional craniotomy: technical description and anatomic assessment. Neurosurgery. 2007;61(5 Suppl 2):256–64; discussion 64–5
Yasargil MG, Antic J, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol. 1976;6(2):83–91.
Kadri PA, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg. 2004;100(3):517–22.
Yasargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987;67(3):463–6.
Jallo GI, Bognar L. Eyebrow surgery: the supraciliary craniotomy: technical note. Neurosurgery. 2006;59(1 Suppl 1):ONSE157–8; discussion ONSE-8.
Stamates MM, Wong AK, Bhansali A, Wong RH. Supraorbital keyhole craniotomy for basilar artery aneurysms: accounting for the "cliff" effect. Oper Neurosurg (Hagerstown). 2017;13(2):182–7.
Hernesniemi J, Ishii K, Niemela M, Smrcka M, Kivipelto L, Fujiki M, et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir Suppl. 2005;94:17–21.
Cha KC, Hong SC, Kim JS. Comparison between lateral supraorbital approach and pterional approach in the surgical treatment of unruptured intracranial aneurysms. J Korean Neurosurg Soc. 2012;51(6):334–7.
Zabramski JM, Kiris T, Sankhla SK, Cabiol J, Spetzler RF. Orbitozygomatic craniotomy. Technical note. J Neurosurg. 1998;89(2):336–41.
Seckin H, Avci E, Uluc K, Niemann D, Baskaya MK. The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus. 2008;25(6):E4.
Aziz KM, Froelich SC, Cohen PL, Sanan A, Keller JT, van Loveren HR. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir. 2002;144(1):15–24.
Day JD, Fukushima T, Giannotta SL. Cranial base approaches to posterior circulation aneurysms. J Neurosurg. 1997;87(4):544–54.
Sorkin GC, Dumont TM, Eller JL, Mokin M, Snyder KV, Levy EI, et al. Cerebrovascular neurosurgery in evolution: the endovascular paradigm. Neurosurgery. 2014;74(Suppl 1):S191–7.
Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, et al. The barrow ruptured aneurysm trial: 3-year results. J Neurosurg. 2013;119(1):146–57.
Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke. 2013;44(7):2046–54.
Avci E, Dagtekin A, Akture E, Uluc K, Baskaya MK. Microsurgical anatomy of the vein of Labbe. Surg Radiol Anat. 2011;33(7):569–73.
Zhao X, Tayebi Meybodi A, Naeem K, Belykh E, Labib MA, Baranoski JF, et al. The Glossopharyngo-Cochlear triangle-part I: quantitative anatomic analysis of high-riding posterior inferior cerebellar artery aneurysms exposed through the extended retrosigmoid approach. Oper Neurosurg (Hagerstown). 2021;20(3):242–51.
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Gomez-Paz, S., Enriquez-Marulanda, A., Nwajei, F., Ogilvy, C.S. (2022). Basics of Craniotomy. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-88196-2_4
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DOI: https://doi.org/10.1007/978-3-030-88196-2_4
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