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Plical resection in pre-temporal approach for basilar bifurcation aneurysms: preliminary surgical experience and cadaveric study

  • Clinical Article
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Summary

Object. Although a pre-temporal approach (PA) can provide a wide space for preservation of thalamoperforating atrteries in direct surgery for basilar bifurcation aneurysms (BBAs), it cannot always secure adequate proximal control. The authors described the advantages of plical resection added to PA for BBAs.

Methods. Between October 1998 and April 2000, eight consecutive patients with BBAs were treated in the neurosurgical department of Kurashiki Central Hospital. Among them, five patients received direct clipping using this method. There were four females and one male, ages ranging from 61 to 77 (mean 70.8 years). Mean aneurysmal size and distance between the in"terclinoidal line and the aneurysmal neck was 4.5 and 9.5 mm, respectively. The operative procedures consisted of the following components; 1) fronto-temporal craniotomy with translocation of orbito-zygomatico-malar bone for PA, 2) preservation of lateral branches of the superficial sylvian veins, 3) resection of plica dural folds to increase the operative field up to the oculomotor nerve (OMN).

Results. Complete clipping was achieved without thalamic infarction or temporal contusion in all patients. Three of the five patients suffered from transient right OMN palsy which recovered within two months after surgery.

Conclusion. Plical resection in the pre-temporal approach might be beneficial in the surgical treatment of BBAs when proximal control seems difficult.

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Abbreviations

APC:

Anterior clinoid process

APCP:

Anterior petroclinoid plica

ETA:

Extradural temporo-polar approach

OMN:

Oculomotor nerve

PA:

Pre-temporal approach

PCP:

Posterior clinoid process

PPCP:

Posterior petroclinoid plica

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Authors and Affiliations

  1. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

    K.-I. Kikuta, Y. Arakawa, M. Hojo, A. Ishii, K. Nozaki & N. Hashimoto

  2. Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan

    S. Yamagata

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  1. K.-I. Kikuta
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  2. S. Yamagata
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  3. Y. Arakawa
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  4. M. Hojo
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  5. A. Ishii
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  6. K. Nozaki
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  7. N. Hashimoto
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Correspondence to K.-I. Kikuta.

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Correspondence: Ken-ichiro Kikuta, Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin Sakyoku, Kyoto 606-8507, Japan.

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Kikuta, KI., Yamagata, S., Arakawa, Y. et al. Plical resection in pre-temporal approach for basilar bifurcation aneurysms: preliminary surgical experience and cadaveric study. Acta Neurochir (Wien) 150, 749–756 (2008). https://doi.org/10.1007/s00701-008-1568-z

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