Temporopolar (Half-and-Half) Approach to the Basilar Artery and the Retrosellar Space

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 the subtemporal approach provides a good view of the basilar artery at the level of the tentorium, it is limited in its rostral visualization, which can be necessary for high-riding basilar apex aneurysms or tumors with significant superior extension. Also, the flat trajectory of this approach limits the ability to see the retrosellar space.

• The temporopolar approach combines these approaches largely through microsurgical mobilization of the temporal lobe, which is retracted posteriorly and laterally to add the exposure of the tentorial incisura to the visualization obtained with a transsylvian approach.