Additional videos for this topic are available online at . Indications Distal anterior cerebral artery (DACA) aneurysms are usually small with a relatively broad base, are distally located, and have one or more branches originating from their base. These…
Indications We prefer surgical clipping of most ruptured and unruptured middle cerebral artery (MCA) aneurysms because of the accessibility of their location and the relatively low morbidity and durability of clipping compared with endovascular therapy. The exception is in patients…
Additional videos for this topic are available online at . Indications for Craniotomy Ruptured Aneurysm All paraclinoid aneurysms presenting with subarachnoid hemorrhage that are unfavorable for endovascular treatment. Paraclinoid ruptured aneurysms with Hunt and Hess grade I, II, or…
Indications Absolute Subarachnoid hemorrhage with intraparenchymal hemorrhage requiring emergent evacuation Subarachnoid hemorrhage with posterior communicating artery (Pcomm) aneurysm not repairable using endovascular techniques Strong Aneurysm presenting with symptoms referable to mass effect, classically presenting as ophthalmoplegia caused by direct compression…
Indications Absolute Subarachnoid hemorrhage with intraparenchymal hemorrhage requiring emergent evacuation Subarachnoid hemorrhage with anterior communicating artery (Acomm) aneurysm not repairable using endovascular techniques Strong Aneurysm presenting with symptoms referable to mass effect Unruptured aneurysm (≥ 7 mm) in a patient…
Indications The retrolabyrinthine approach is a hearing-preserving presigmoid approach that uses a mastoidectomy and skeletonization of the sigmoid sinus to expose the presigmoid dura behind the semicircular canals. The principal appeal of this approach is its ability to expose widely…
Indications The middle fossa approach is a largely extradural approach to the bony structures that make up the floor of the middle fossa. Although the convex floor of the middle fossa is the most straightforward region to access with this…
Indications Transsylvian approaches enter the parasellar cisterns on a superior-to-inferior trajectory, forcing the surgeon to work past the carotid artery through the opticocarotid or carotid-oculomotor triangles to access this region, making access of the midbasilar and interpeduncular cisterns difficult. Although…
Indications The suboccipital approach with C1 laminectomy provides adequate visualization of approximately 270 degrees of the circumference around the medulla. This approach does not provide safe access to the 90 degrees anterior to the medulla, however, because the visual angle…
Indications The unilateral and bilateral subfrontal approaches are the workhorse approaches for access to nearly the entire anterior cranial fossa floor; anterior midline parasellar structures such as the tuberculum sella, anterior communicating artery, and optic chiasm; posterior orbit; and orbital…