{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T14:20:42Z","timestamp":1776954042816,"version":"3.51.4"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5]]},"abstract":"OBJECTIVE<\/jats:title>Pathology in the region of the basilar quadrifurcation, anterolateral midbrain, medial tentorium, and interpeduncular and ambient cisterns may be accessed anteriorly via an orbitozygomatic (OZ) craniotomy. In Part 1 of this series, the authors explored the anatomy of the oculomotor-tentorial triangle (OTT). In Part 2, the versatility of the OTT as a surgical workspace for treating vascular pathology is demonstrated.<\/jats:p><\/jats:sec>METHODS<\/jats:title>Sixty patients with 61 vascular pathologies treated within or via the OTT from 1998 to 2017 by the senior author were retrospectively reviewed. Patients were grouped together based on pathology\/surgical procedure and included 1) aneurysms (n = 19); 2) posterior cerebral artery (PCA)\/superior cerebellar artery (SCA) bypasses (n = 24); 3) brainstem cavernous malformations (CMs; n = 14); and 4) tentorial region dural arteriovenous fistulas (dAVFs; n = 4). The majority of patients were approached via an OZ craniotomy, wide sylvian fissure split, and temporal lobe mobilization to widen the OTT.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>Aneurysm locations included the P1<\/jats:sub>-P2<\/jats:sub> junction (n = 7), P2A<\/jats:sub> segment (n = 9), P2\/3<\/jats:sub> (n = 2), and basilar quadrification (n = 1). Aneurysm treatments included clip reconstruction (n = 12), wrapping (n = 3), proximal occlusion (n = 2), and trapping with (n = 1) or without (n = 1) bypass. Pathologies in the bypass group included vertebrobasilar insufficiency (VBI; n = 3) and aneurysms of the basilar trunk (n = 13), basilar apex (n = 4), P1<\/jats:sub> PCA (n = 2), and s1<\/jats:sub> SCA (n = 2). Bypasses included M2<\/jats:sub> middle cerebral artery (MCA)\u2013radial artery graft (RAG)\u2013P2<\/jats:sub> PCA (n = 8), M2<\/jats:sub> MCA\u2013saphenous vein graft (SVG)\u2013P2<\/jats:sub> PCA (n = 3), superficial temporal artery (STA)\u2013P2<\/jats:sub> PCA (n = 5) or STA\u2013s1<\/jats:sub> SCA (n = 3), s1<\/jats:sub> SCA\u2013P2<\/jats:sub> PCA (n = 1), V3<\/jats:sub> vertebral artery (VA)\u2013RAG\u2013s1<\/jats:sub> SCA (n = 1), V3<\/jats:sub> VA\u2013SVG\u2013P2<\/jats:sub> PCA (n = 1), anterior temporal artery\u2013s1<\/jats:sub> SCA (n = 1), and external carotid artery (ECA)\u2013SVG\u2013s1<\/jats:sub> SCA (n = 1). CMs were located in the midbrain (n = 10) or pontomesencephalic junction (n = 4). dAVFs drained into the tentorial, superior petrosal, cavernous, and sphenobasal sinuses. High rates of aneurysm occlusion (79%), bypass patency (100%), complete CM resection (86%), and dAVF obliteration (100%) were obtained. The overall rate of permanent oculomotor nerve palsy was 8.3%. The majority of patients in the aneurysm (94%), CM (93%), and dAVF (100%) groups had stable or improved modified Rankin Scale scores.<\/jats:p><\/jats:sec>CONCLUSIONS<\/jats:title>The OTT is an important anatomical triangle and surgical workspace for vascular lesions in and around the crural and ambient cisterns. The OTT can be used to approach a wide variety of vascular pathologies in the region of the basilar quadrifurcation and anterolateral midbrain.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.2.jns173141","type":"journal-article","created":{"date-parts":[[2018,6,29]],"date-time":"2018-06-29T13:59:48Z","timestamp":1530280788000},"page":"1435-1445","source":"Crossref","is-referenced-by-count":8,"title":["The oculomotor-tentorial triangle. 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