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Objective: cerebral peduncle pool (interpeduncular cistern, IC) deep, the basilar artery (basilarartery, BA) is the important structure of this area. Intracranial aneurysm, vertebral - basilar artery (vertebral-basilar artery, VBA) aneurysm is rare, accounting for about 3.8% to 15%, while the BA aneurysm VBA aneurysms account for about 40%, because it is located in cranial fossa deep, involving the brainstem, cranial nerves, perforating artery and other important structures, once rupture poor prognosis, postoperative mortality and morbidity rate in the anterior circulation aneurysms. Relatively more the VBA giant aneurysms (diameter> 2cm), it was reported, VBA's giant aneurysms account for about 66% to 87%, untreated giant aneurysms in 5 years, more than 80% of serious disability or even death (due to the compression of the brain stem, severe arterial embolization, etc.). BA aneurysm treatment is mainly two: First, endovascular treatment, commonly used coil embolization, the preferred treatment for posterior circulation aneurysms, but its indications narrower. Another craniotomy for aneurysm clipping surgery, surgery significantly increased the difficulty of the deep, multi-lesion location close relationship with the brain, brainstem, revealed difficulties, limited surgical space. The BA aneurysm surgical approach reported in the literature there are many, used temporal sigmoid sinus pterional (pterional approach, PA), its common drawback brain retraction, deep lighting small operating space, in most cases, the proximal end of the parent artery is difficult to control. Orbitozygomatic approaches (orbitozygomatic approach, OZ) through the mill in addition to the part of the skull base, can significantly increase the region revealed. OZ can be exposed to the area of ??the cavernous sinus, IC, tip of the petrous bone, temporal fossa. Some huge skull base tumors, complex vascular lesions, compared with other approaches, this approach in terms of the operative space and perspective, or in reducing the pulling of the brain tissue, has irreplaceable advantages. Yet OZ complicated operation, the instrument requires difficult to affect its popularization and application. It is particularly important that the processing deep lesions, the light illumination with increasing depth decremented lesion easily exposed surrounding tissue, surgery may appear dead ends under the microscope. Whether endovascular intervention or craniotomy clipping of intracranial aneurysms, its purpose is to exclude the aneurysm from the normal circulation outside the brain, in order to prevent it from bleeding. At the same time the need to protect its parent artery, the the important wear through support around the important anatomic structures, BA aneurysm surgery death or disability is the most important reason major wear vessel occlusion. While the endoscope deep Lighting helpful, its biggest advantage is able to display the information of the back side of the aneurysm can also display the branch, the penetrating branch as well as whether the aneurysm completely clipping. However the endoscopic assisted orbitozygomatic approaches (endoscope assisted orbitozygomatic approach, EAOZ) deal with BA aneurysm little anatomical study rarely reported. This experiment OZ a new orbital cheekbones flap forming method, in order to streamline operations, reduce trauma. People IC anatomic structure under the microscope and endoscope observation and study, comparing the two exposed differences, while familiar the IC District microscope and endoscopic anatomical relationship, especially some of the arachnoid structure. For the surgical treatment of lesions in help. Methods: 8 cases of 16 sides fully fixed in 10% formalin adult cadaveric heads arterial system injected with red latex to imitate actual operative cadaver rack fixed on the anatomy of the head, ready to conventional craniotomy equipment. To expand PA scalp incision edge of the from the tragus 1cm zygomatic arch do curved incision terminated in the contralateral pupil midline point of intersection of the hairline. In this study, two flap-OZ improved, first formed frontotemporal bone flap with traditional PA flap bone hole locations, the introduction of a key hole, this hole in the amount of butterflies at 1cm seam on the zygomatic process, this The hole just to expose the orbital periosteum and the anterior cranial fossa subdural. The supraorbital foramen outside of the 2nd hole 0.5cm, superior orbital margin at 1cm. The remaining bone hole with PA. Then form a orbital cheekbone flap: the improved orbital cheekbones flap angioplasty, the key hole just above 2cm at the orbital form on the 3rd hole on top of the key hole in turn communicates with a wire saw - orbital fissure, key hole -3 hole, on the 3rd hole -2 hole, the orbital fissure orbital hole - orbital fissure orbit outside the hole, and finally in the middle portion of the zygomatic arch from cutting zygomatic arch, the formation of the orbital cheekbones flap. Standard manner (C-shaped incision base forward) cut the dura mater, the open side of the split from distal to proximal. Reveal tentorial gap before and BA the end, observed Liliequist film (Liliequist's membrane, ML) and its leaf. Open ML, enter the IC, careful separation arachnoid, observed after bilateral traffic the artery (posteriorcommunicaing artery, PCoA), posterior cerebral artery (posterior cerebral artery, PCA), superior cerebellar artery SCA (superior cerebellar artery, SCA) revealed the scope and important vascular branch. Has observed IC anatomic structure of BA and its branches in the most remote measurement that can be observed under the microscope and endoscope. Using SPSS11.0 statistical software of the measured data processing using the pairing metering t test was used for statistical analysis, p <0.05 was considered statistically significant. Results: 1. Introduction of improved OZ key hole and 3 hole to reduce the difficulty of the surgical procedure, reduce the trauma, of resected orbital roof and orbital wall area than traditional surgical increasing favor postoperative reconstruction . 2.IC composed of two parts of the shallow and deep, the free shallow, deep vascular tissue. Central pool, the bridge before the pool, the carotid pool, cerebellopontine angle pool, oculomotor pool phase traffic. Under the microscope observed BA length: 16.34 ± 3.16 mm endoscopic observation of the length of the observed BA: 25.22 ± 4.38mm. Endoscope under, as a significant increase (p <0.05). 4. The ipsilateral PCA depending on the length of the microscope, endoscopic no significant difference (p> 0.05), depending on the length of ipsilateral and contralateral SCA, contralateral PCA under the microscope and endoscope significant difference (p < 0.05). Conclusion: 1. Use of improved OZ key hole and 3 hole, which selected bits of the key hole is very important. 2.EAOZ contrast microscopy, can be significantly increased, particularly in the surgical field contralateral exposure significantly improved, the exposure range of BA and its branches endoscope deep lighting good. 3.EAOZ contrast microscope, can be more clearly observed, is conducive to the operation of the skull base deep brain and small perforating artery running. 4. Application Neuroendoscope should attach importance to endoscopic the IC anatomic relationship, in particular, should pay attention to this area arachnoid structure.
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