Skull Base Approaches to Cerebrovascular Pathologies: Surgical Strategies and Outcome Analysis

Background: Recent advances in endovascular techniques have diminished neurosurgeons’ exposure to common vascular pathologies and cerebrovascular surgeons have been treating more challenging cases in recent years. Therefore, expertise in skull base approaches seems inevitable for those treating such complex pathologies. In this study, we reviewed all vascular lesions treated with skull base approaches in our hospital and analyzed their outcome considering our strategies in selecting surgical approaches.

Methods: Operative notes, pre- and postoperative images, and follow up notes of all the patients with vascular pathologies operated in the last five years were reviewed and those patients operated with skull base approaches were enrolled. Clinical and radiological outcomes were collected.

Results: Among the patients treated for vascular pathologies, 29 patients underwent skull base approaches (7 males, mean age: 53.7 ± 13.0). Patients were approached for aneurysm clipping (10 cases), cerebral revascularization (2 for vertebrobasilar insufficiency, 1 for moyamoya, 6 for giant or dissecting aneurysms), arteriovenous fistulae (4 cases), or brain stem cavernomas (6 cases). These approaches included far lateral, orbitozygomatic, retrolabyrinthine, and frontobasal in descending order of frequency. No major approach related complication was observed.

Conclusion: Our results showed that excellent outcome can be achieved for treating aneurysms, cavernoma, arteriovenous fistulae, or performing intra-cranial extra-cranial arterial revascularization with using skull base approaches. Less brain retraction and wider surgical exposure are the advantages that cannot be achieved with conventional approaches.