Limited Intradural Anterior Petrosectomy for Upper Basilar Aneurysms: A Technical Note

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cerebrovascular Surgery

Background:

• The extradural anterior petrosectomy is a common skull base approach but involves significant morbidity and requires complete petrosectomy.
• Intradural structures are not visible during drilling, limiting the extradural approach.

Observation:

• A modified intradural anterior petrosectomy technique is described for accessing aneurysms of the basilar trunk and anterior inferior cerebellar artery.
• The approach involves a temporal craniotomy, dural opening, and precise dissection around cranial nerves.

Findings:

• Two patients with basilar trunk perforator and anterior inferior cerebellar artery aneurysms were successfully treated using this tailored intradural approach.
• The procedure allowed for limited petrous apex drilling while providing adequate exposure.

Implications:

• The intradural anterior petrosectomy offers a viable alternative for managing complex basilar artery aneurysms.
• This technique may reduce procedure-related morbidity compared to the traditional extradural approach.