Cranial base approaches to large and giant aneurysms

Large and giant aneurysms are difficult to treat because of their size, broad or absent neck, and incorporation of the parent vessels or perforators in the aneurysm wall. For the surgical treatment of large and giant aneurysms, cranial base approaches are essential because they provide improved working space, reduce brain retraction, and facilitate hypothermic cardiac arrest or vascular procedures. One hundred sixty-three cranial base approaches to aneurysms over the last decade are described including orbital and orbitozygomatic osteotomy, transpetrosal (retrolabyrinthectomy, partial labyrinthectomy petrous apicectomy, or total petrosectomy), and extreme lateral transcondylar, and illustrative cases are provided. The complications of the cranial base approaches were minimal and included cerebrospinal fluid leaks.