Zygomatic approach for lesions in the interpeduncular cistern

Area of Science:

• Neurosurgery
• Surgical Anatomy

Background:

• Lesions in the interpeduncular cistern, such as basilar tip aneurysms, craniopharyngiomas, and chordomas, pose significant surgical challenges due to their location.
• Optimal surgical access to the high interpeduncular fossa often requires extensive brain retraction, increasing risks.

Observation:

• A new surgical technique involving zygomatic arch detachment was developed to improve exposure and minimize brain retraction.
• The procedure involves specific patient positioning and anatomical dissection, including the removal of the zygomatic arch and orbital rim for anterior temporal base access.

Findings:

• The zygomatic approach allows for retrograde opening of Sylvian stem arachnoid membranes and elevation of neurovascular structures (posterior communicating artery, optic tract) to access the interpeduncular cistern.
• This technique facilitated the successful surgical treatment of two patients with basilar tip aneurysms.
• A modified subtemporal zygomatic approach was utilized to treat a craniopharyngioma and a chordoma in two additional patients.

Implications:

• The zygomatic approach provides a valuable alternative for neurosurgeons addressing complex lesions within the interpeduncular cistern.
• This technique potentially reduces operative morbidity by minimizing brain retraction and improving surgical visualization.
• Further clinical application may establish this approach as a standard for specific interpeduncular cistern pathologies.