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Chapter 21 - Combined Transsylvian-Subtemporal Approach to Anterior Circulation and Basilar Apex Aneurysms

from Section II - Open Combined Approaches

Published online by Cambridge University Press:  05 October 2021

By
James G. Malcolm  and
Daniel L. Barrow
Edited by
Vijay Agarwal
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Summary

Traditionally, two approaches have been utilized to access the rostral basilar artery (BA) for clipping aneurysms. These are: 1) the subtemporal approach pioneered by Canadian neurosurgeon Charles George Drake and 2) the transsylvian or pterional approach popularized by Turkish neurosurgeon Mahmut Gazi Yasargil. Both of these approaches have assets and liabilities, and both have modifications to expand the surgical field of view. Some rostral BA aneurysms and some patients with aneurysms of both the anterior and posterior circulation requiring clip ligation may benefit from a combined transsylvian and subtemporal (half-and-half) exposure. In this chapter, we describe our version of that approach, which provides access to both anterior and posterior circulation aneurysms. We detail neuroanesthesia considerations, patient positioning, bone drilling, subarachnoid dissection, and clip placement. Also included is an illustrative case.

Keywords

aneurysmbasilar tipcliptranssylvian-subtemporalhalf-and-halfextended lateral
Type
Chapter
Information
Integrated Management of Complex Intracranial Lesions
Open, Endoscopic, and Keyhole Techniques
 , pp. 214 - 222
Publisher: Cambridge University Press
Print publication year: 2021

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