Basilar aneurysms: a new transclival approach via maxillotomy

Area of Science:

• Neurosurgery
• Vascular Surgery
• Otolaryngology

Background:

• Vertebrobasilar aneurysms pose significant surgical challenges.
• Traditional surgical approaches may involve brainstem retraction or cranial nerve manipulation.

Observation:

• A modified transoral transclival approach utilizing Le Fort I maxillary osteotomy was performed in three patients.
• This technique provided enhanced visualization of the clivus and aneurysms.

Findings:

• The Le Fort I osteotomy facilitated aneurysm exposure without brainstem or cranial nerve traction.
• No postoperative cerebrospinal fluid fistulae or neurological deficits were observed.
• Excellent cosmetic results and no malocclusion issues were reported.

Implications:

• This transoral transclival technique offers a potentially advantageous alternative for managing clival pathologies.
• The approach may be beneficial for treating other diseases affecting the clivus.
• Minimally invasive access and reduced neurological risk are key benefits.