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Posterior Clinoidectomy in the Subtemporal Transtentorial Approach for a Basilar Bifurcation Aneurysm: Technical Note
Yuki Hirose1, Hideyuki Yoshioka1, Koji Hashimoto1
1Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Japan.
World Neurosurgery
|March 16, 2025
Summary
Posterior clinoidectomy with downward posterior petroclinoid ligament (PPL) transition is an effective surgical strategy. This technique expands the surgical field for low-positioned basilar bifurcation aneurysms when using the subtemporal approach.
Area of Science:
- Neurosurgery
- Cerebrovascular Surgery
Background:
- Direct surgical intervention is sometimes necessary for basilar bifurcation aneurysms, even with the prevalence of endovascular treatments.
- The subtemporal transtentorial approach is suitable for low-lying, posteriorly projecting aneurysms.
- The posterior clinoid process typically does not obstruct the surgical view in this approach.
Purpose of the Study:
- To present the first reported use of posterior clinoidectomy to enhance the surgical field during a subtemporal approach for a low-positioned basilar bifurcation aneurysm.
- To demonstrate the utility of posterior clinoidectomy when the posterior petroclinoid ligament (PPL) obstructs the operative field.
Main Methods:
- A 42-year-old female patient underwent surgical neck clipping for a ruptured low-positioned basilar bifurcation aneurysm.
- The right subtemporal transtentorial approach was employed.
- Posterior clinoidectomy was performed using an ultrasonic aspirator with downward PPL transition to overcome operative field obstruction.
Main Results:
- The surgical procedure was successfully completed, enabling safe clipping of the aneurysm.
- The patient was discharged without any neurological deficits.
Conclusions:
- The posterior petroclinoid ligament (PPL) can impede adequate surgical exposure even with the subtemporal approach.
- Posterior clinoidectomy combined with downward PPL transition is an effective method to improve surgical access in challenging cases of basilar bifurcation aneurysms.
