Basilar aneurysms: a new transclival approach via maxillotomy.

A transoral transclival approach to vertebrobasilar aneurysms, using a Le Fort I maxillary osteotomy rather than splitting the soft and hard palates, was employed successfully in three patients. This technique gave much improved access to the clivus, and eased exposure of the aneurysms without the need for traction on the brain stem or cranial nerves. There were no postoperative cerebrospinal fluid fistulae and no neurological complications. In one patient, a human-derived fibrin adhesive was used for dural repair. The postoperative cosmetic results were excellent and no problems relating to malocclusion were reported. This approach may have advantages when dealing with other diseases in or around the clivus.