The orbitozygomatic approach in the surgery of cerebral aneurysms

Objective. To determine the angular parameters of operative wound and observation directions of difficult accessible segments of circle of Willis via orbitozygomatic approach. Material and methods. The orbitozygomatic approach was simulated on 30 anatomical specimens during our study. The angular parameters of operative wound and accessibility of basal observation of А1 segment of anterior cerebral and anterior communicating arteries, clinoid segment of internal carotid artery and bifurcation of middle cerebral artery as well as basilar tip and orifice of anterior inferior cerebellar artery were estimated. The assessment of operative wound parameters consisted of measurement of projection, vertical and horizontal angles and depth of wound. All approaches were performed on anatomical specimens using operative microscope MBS-10, routine set of neurosurgical instruments and high speed neurosurgical bone drill. Results. The orbitozygomatic approach decreases the projection angles for difficult accessible segments of circle of Willis. The vertical operative angles increased by 2 times for А1 segment of anterior cerebral and anterior communicating arteries, by 2-4 times for clinoid segment of internal carotid artery, by 1,5 times for bifurcation of middle cerebral artery and by 3-8 times for basilar tip comparing with pterional approach. The vertical angles increases by 3-4 times for orifice of anterior inferior cerebellar artery while using orbitozygomatic transcavernous approach comparing with retrosigmoid approach and by 1,5 times comparing with orbitozygomatic approach. Conclusions. The orbitozygomatic approach is the general for achieving of aneurysms located on difficult accessible segments of circle of Willis as well as for aneurysm dissection and clipping as well as for various variants of transcavernous approaches and extended approaches via floor of middle cerebral fossa (anterior petrosectomy) as well as for temporopolar extradural, preauricular infratemporal and combined postauricular transpetrosal apprpaches with transposition (or without) of internal carotid artery, VII nerve and sigmoid sinus.

орбитозигоматический доступ, угловые параметры операционной раны, артериальная аневризма, orbitozygomatic approach, angular parameters of operative wound, cerebral aneurysm

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