title: Subtemporal approach for distal basilar occlusion for giant aneurysm. Nuances and advantages of the subtemporal approach.
abstract: We described the subtemporal approach, which was used for distal basilar artery occlusion in a patient with a symptomatic giant unclippable aneurysm. We discuss issues related to positioning and lumbar drainage. We illustrate the basic steps: identification of the tentorial notch; sharp opening of the arachnoid behind the third nerve; placement of a fixed mechanical retractor to "hold" the brain; identification of the third nerve and mobilization from arachnoid attachments; identification of the course and insertion of the fourth nerve; division and retraction of the tentorial edge to enhance exposure; preparation of the "perforator-free zone"; and final clip application followed by ICG fluorescein angiography. We show some of the areas exposed with this approach. The video can be found here: http://youtu.be/S_NLIjKQL_o .
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Delia
authors.initials: D
authors.lastname: Cannizzaro
authors.forename: Stefano Lorenzo
authors.initials: SL
authors.lastname: Villa
mesh_terms: D001488:Basilar Artery / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008866:Microsurgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010294:Parietal Bone / Q000601:surgery*; D013525:Surgical Instruments
keywords: basilar artery; intracranial aneurysm; subtemporal approach; tentorial edge; unclippable aneurysm