Skull Base 2011; 21(1): 023-030
DOI: 10.1055/s-0030-1262946

© Thieme Medical Publishers

Accessing the Basilar Artery Apex: Is the Temporopolar Transcavernous Route an Anatomically Advantageous Alternative?

Hakan Sabuncuoğlu1 , Pakrit Jittapiromsak1 , Daniel D. Cavalcanti1 , Robert F. Spetzler1 , Mark C. Preul1
  • 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Publication History

Publication Date:
26 July 2010 (online)


The restricted operative field, difficulty of obtaining proximal vascular control, and close relationship to important anatomic structures limit approaches to basilar apex aneurysms. We used a cadaveric model to compare three surgical transcavernous routes to the basilar apex in the neutral configuration. Five cadaveric heads were dissected and analyzed. Working areas and length of exposure provided by the transcavernous (TC) approach via pterional, orbitozygomatic, and temporopolar (TP) routes were measured along with assessment of anatomic variation for the basilar apex region. In the pterional TC and orbitozygomatic TC approaches, the mean length of exposure of the basilar artery measured 6.9 and 7.2 mm, respectively (p = NS). The mean length of exposure in a TP TC approach increased to 9.3 mm (p < 0.05). Compared with the pterional and orbitozygomatic approaches, the TP TC approach provided a larger peribasilar area of exposure ipsilaterally and contralaterally (p < 0.05). The multiplanar working area related to the TP TC approach was 77.7 and 69.5% wider than for the pterional TC and orbitozygomatic TC, respectively. For a basilar apex in the neutral position, the TP TC approach may be advantageous, providing a wider working area for the basilar apex region, improving maneuverability for clip application, fine visualization of perforators, and better proximal control.


Mark C Preul, M.D. 

Newsome Chair of Neurosurgery Research, Barrow Neurological Institute, Division of Neurological Surgery

St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013