title: Quantitative analysis of the trajectory of simulated basilar apex aneurysms through the internal carotid artery to assess the need for an orbitozygomatic approach.
abstract: The aim of this study was to identify the correlation between the location of the internal carotid artery (ICA) and the need for an orbitozygomatic approach (OZA) when approaching a basilar apex (BX) aneurysm.
  
  
  
  By imaging the virtual trajectory to access the basilar artery (BA) through the ICA, the correlations among the height of the BX, the height and lateral breadth of the bifurcation of the ICA, and the need for removal of the orbital rim or zygomatic arch were investigated using three-dimensional computed tomography angiography (3DCTA) data of approximately 80 random samples not limited to BX aneurysms. Furthermore, the utility of 3D simulation to determine the need for the OZA was verified using data from five patients with BX aneurysms.
  
  
  
  The height of the bifurcation of the ICA was inversely correlated and the height of the BX was positively correlated with the need for the OZA (both p < 0.017). Among patients undergoing surgery, clipping was successfully performed without the OZA in two patients in whom the distance from the simulated skull point on the extended line from the BX through the bifurcation of the ICA was more than 4 cm from the zygoma and orbital rim.
  
  
  
  It is necessary to determine the spatial relationship between the basilar artery and the ICA to decide whether the OZA is needed for surgery. Correlations of the height of the ICA and BX with the need for the OZA were not very strong individually, though they were significant. Therefore, simulation using 3DCTA appears to be important for planning the surgical approach for the treatment of BX aneurysms.
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. myasushi@naramed-u.ac.jp.
authors.forename: Yasushi
authors.identifier: 0000-0003-1957-2124
authors.initials: Y
authors.lastname: Motoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hironaka
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nishimura
authors.affiliation: Ohnishi Neurological Center, Akashi, Hyogo, Japan.
authors.forename: Pritam
authors.initials: P
authors.lastname: Gurung
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sasaki
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeshima
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Matsuda
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015050:Zygoma / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: 3D simulation; 3DCTA; Basilar apex aneurysm; Internal carotid artery; Orbitozygomatic approach