OBJECTIVE: Cranial base approaches that involve radical petrosectomy are associated with significant rates of morbidity. We have sought alternative approaches to the midbasilar artery to reduce the extent of temporal bone removal and correspondingly to reduce complications while still providing adequate surgical exposure. The extended orbitozygomatic and far-lateral approaches are two such approaches. We compared our experience with these approaches to our experience with the standard transpetrosal approaches in the treatment of midbasilar @entity438 . METHODS: Between 1990 and 1995, 28 @entity1 with large and @entity438 were treated with approaches involving either radical or conservative petrosectomy. RESULTS: Overall, good outcomes (Glasgow Outcome Scale scores of 1 and 2) were observed in 21 @entity1 (75%), and three @entity1 (11%) had permanent treatment-associated @entity51 . Four @entity1 died. Later in the series, the pterional-subtemporal approach (four @entity1 ) was supplanted by the orbitozygomatic approach (six @entity1 ). The increased use of hypothermic @entity1167 involved exposure of the midbasilar region from above (orbitozygomatic approach) and below (far-lateral approach, 13 @entity1 ). Concomitantly, the use of transpetrosal approaches (five @entity1 ) decreased. CONCLUSION: Modified orbitozygomatic and far-lateral approaches adequately expose the midbasilar region and can replace transpetrosal approaches in some cases. These extended approaches can be associated with lower morbidity rates than can transpetrosal approaches. Hypothermic @entity1167 is critical to clipping large and @entity438 directly when approaches that conserve the temporal bone are used.

Technical aspects and recent trends in the management of large and XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity51 :: ('MESH:D009461', 'Disease') :: ['neurological deficits'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['circulatory arrest'] @entity438 :: ('MESH:D002532', 'Disease') :: ['artery aneurysms', 'giant midbasilar artery aneurysms']
@entity438 :: (MESH:D002532,Disease) :: ['giant midbasilar artery aneurysms']
