The effect of orbitozygomatic access for ruptured basilar and related aneurysms on management outcome

Abstract

Despite increasing use of craniofacial access for complex intracranial and skull base pathology, there have been no reports detailing the impact of improved access on clinical outcome. Orbitozygomatic access was used in 32 patients with an aneurysm of the basilar bifurcation, superior cerebellar, or posterior cerebral arteries over a 9-year period. Operative mortality was 0%, overall management mortality 9% and management morbidity was 9%. This approach was selected for these patients because of the anatomy of the aneurysm and its relationship to the terminal basilar complex and the dorsum sellae/posterior clinoid process. The flexibility achieved by the access allowed intraoperative use of multiple corridors of access. Morbidity directly attributable to the use of orbitozygomatic access was minimal. While management outcome after aneurysmal subarachnoid hemorrhage relates directly to the severity of the initial hemorrhage, rather than the surgical approach chosen, in selected patients we recommend the use of this approach as a valuable adjunct to the armamentarium of the vascular neurosurgeon.