Aneurysms of the distal basilar artery present one of the greatest therapeutic challenges in neurosurgery. Pioneering work by Dr. Charles Drake and Dr. Gazi Yasargil allowed us to consider these lesions surgically accessible and treatable. The lessons learned from their respective approaches to distal basilar aneurysms, through decades of experience, have allowed advances in the therapy of these lesions. Dr. Drake advocated a subtemporal approach; Dr. Yasargil used a transsylvian approach. As we shall see, each of these approaches has advantages and disadvantages when approaching aneurysms in the interpeduncular cistern. Modifications on their techniques by various groups, including the authors', has led to an approach that combines the merits of each while eliminating some of the limitations. The authors propose the name 'pterional approach via the extended lateral corridor' (PAVEL) for this approach, which will be describe in this article. This approach is a hybrid of Dr. Drake's 'half and half.' Although this approach is not suitable or necessary for all basilar apex aneurysms, the authors have found it advantageous for many aneurysms and even neoplastic conditions in this location.
- Frontal transsylvian corridor
- Pterional craniotomy
- Subtemporal approach
ASJC Scopus subject areas
- Clinical Neurology