The microsurgical anatomy study of basilar artery apex via subtemporal approach

Objective To explore the scope of the bifurcation of basilar artery(BA) via subtemporal approach,and provide reference for the microsurgery of BA apex lesion.Methods Ten(20 sides)adult cadaveric specimens which perfused with colored silicone were studied by using subtemporal approach under the microscope,We observed and measured the relationship among the important neurovascular structures and described the exposure scope of the bifurcation of basilar artery.Results The shortest distances from the zygomatic arch to the edge of tentorium incisura was 39.24±1.27mm.We found that the trochlear nerve entered the edge of tentorium in post-lateral PCP.The mean distance was 15.72±3.81mm.The subtemporal approach could provide wide exposure for the base of the middle cranial fassa and perforating arteries arising from BA bifurcation and P1 segment.Conclusion The subtemporal approach has advantages such as shorter distance of operation,bigger straight visual angle.We can observe the perforating branches arising from BA bifurcation and P1 segment though lateral wider visual field,when clipping the aneurysm which directed backward.Cutting the tentorium at the post-lateral 17mm point away from PCP can avoid damaging the trochlear nerve.The exposure of the BA apex can be increased after cutting tentorium,and a wider scope of expoure is obtained to the lateral aspect of the brainstem.