Orbitozygomatic approach to basilar apex aneurysms.

Basilar apex region aneurysms are among the most complex cerebral aneurysms. They are not, however, among the most common aneurysms, and increased use of endovascular treatment has further decreased the number of patients with these lesions who undergo surgery. Nonetheless, not all basilar apex aneurysms are amenable to coil embolization, and neurosurgeons must be prepared to treat patients with basilar apex aneurysms surgically. We prefer an orbitozygomatic craniotomy and transsylvian approach. Meticulous exercise of the basic tenets of aneurysm surgery (proximal vascular control, sharp dissection, and preservation of perforating vessels) is crucial to optimal patient outcomes.