19 Basilar Artery Bifurcation Aneurysms Microsurgical Anatomy The basilar artery terminates in a quadrifurcation from which two posterior cerebral arteries (PCAs) and two superior cerebellar arteries (SCAs) originate (Fig. 19.1)….
14 Posterior Communicating Artery Aneurysms Microsurgical Anatomy The posterior communicating artery (PCoA) bisects the supraclinoid internal carotid artery (ICA) into an ophthalmic segment from the distal dural ring to the…
18 Pericallosal Artery Aneurysms Microsurgical Anatomy The anterior cerebral artery (ACA) distal to the anterior communicating artery (ACoA) is divided into four segments (Fig. 18.1). The A2 segment, also called…
6 Permanent Clipping Clip Application Applying a permanent clip on an aneurysm neck is like landing an airplane, requiring just the right “yaw, pitch, and roll” (Fig. 6.1A). Pitch refers…
2 Subarachnoid Dissection The Subarachnoid Cisterns The subarachnoid space is the arena of aneurysm surgery because it houses the brain’s arteries and provides a navigable labyrinth to deep targets that…
13 Far-Lateral Approach Position The far-lateral approach is also called the lateral suboccipital approach, the extreme lateral approach, and the extreme lateral inferior transcondylar exposure (ELITE). A modified park-bench or…
10 Pterional Approach Position The patient is positioned supine with a bolster under the shoulder ipsilateral to the aneurysm. The head is rotated 15 to 20 degrees away from the…
11 Orbitozygomatic Approach Rationale and Indications The orbitozygomatic approach dramatically enhances the standard pterional craniotomy. When a patient’s head is rotated away from the aneurysm and extended, the superior and…
12 Anterior Interhemispheric Approach Position, Incision, and Extracranial Dissection Pericallosal artery (PcaA) aneurysms originate from a right-or left-sided bifurcation of the anterior cerebral artery (ACA), but are midline aneurysms deep…
8 Brain Transgression Violation Vascular neurosurgery is a refined art. The dexterity, grace, and precision of a master neurosurgeon are awe-inspiring; the movement of microsurgical instruments among arteries and nerves…
