Manejo microquirúrgico de aneurisma roto del top de la arteria basilar. Alternativa mínimamente invasiva.

Abstract

Introduction: Aneurysms of posterior circulation have a higher risk of causing subarachnoid hemorrhage compared to those of anterior circulation and have a low frequency, within this group, those at the top of the basilar, has a prevalence of 7% of cerebral aneurysms. Usually the treatment is by endovascular route, but in some cases, considering the advance of microsurgery and minimally invasive accesses, it allows us to resolve aneurysms of posterior circulation, this has allowed us to expand the microsurgical indications of posterior circulation aneurysms. The minipterional approach, which is a variant of the classic pterional approach, has gained popularity in recent years, largely because it is minimally invasive and allows us to approach vascular structures of both the anterior circulation and some of the posterior circulation, with less morbidity tan other previously described approaches. Objective: To carry out an anatomical description of the interfascial minipterional approach combined with extradural anterior clinoidectomy, for the clipping of aneurysms from the top of the basilar artery. Material and Methods: An anatomical description of the interfascial minipterional access combined with extradural anterior clinoidectomy is performed for clipping of the aneurysm of the top of the basilar and a case of aneurysm of the top of the basilar basilar is described, resolved by this route. Discussion: For aneurysmal pathology of posterior circulation, the usual treatment is endovascular, however there are cases, such as aneurysms of the top of the basilar, which in expert hands, can be resolved with low morbidity, by minimally invasive access. Conclusions: The minipterional approach constitutes a safe access route, minimally invasive and that allows us to cover a wide variety of aneurysmal pathology locations, combined with the extradural anterior clinoidectomy, it is possible to safely and comfortably access the top of the basilar, with minimal morbidity in patients.