Operation on high-lying basilar bifurcation aneurysms

The surgical approach to basilar bifurcation aneurysms is a complicated procedure, especially with those located high in the interpeduncular cistern. We have developed a surgical approach to these aneurysms involving only a small anterior temporal craniotomy and detachment of the zygomatic arch.

The skin incision is placed 5 mm below the inferior border of the zygomatic arch and 5 mm anterior to the tragus, extending on towards the eyebrow but well within the hairline. The zygomatic arch is detached on either side followed by a small temporal craniotomy exposing the anterior temporal lobe. The temporal lobe is retracted and the internal carotid artery, posterior cerebral artery, posterior communicating artery, and inferior aspect of the optic chiasma are exposed.

We have performed a transzygomatic anterior subtemporal approach in 12 patients with high-lying basilar bifurcation aneurysm. Eight patients demonstrated a good recovery as per the Glasgow outcome scale and four patients had a moderate disability that correlated with a poor WFNS grade preoperatively. One patient had an oculomotor palsy and another experienced a small infarction postoperatively.

This approach is a suitable procedure for high-lying basilar bifurcation aneurysms in the interpeduncular cistern and 1.2 cm above the clinoid process.