The Expanded Endoscopic Endonasal Approach to Anterior Communicating Artery Aneurysms: A Cadaveric Morphometric Study

Unnithan, Ajay S.; Omofoye, Oluwaseun A.; Lemos-Rodriguez, Ana M.; Sreenath, Satyan B.; Doan, Vivian; Zanation, Adam M.; Recinos, Pablo F.; Sasaki‐Adams, Deanna

doi:10.1016/j.wneu.2015.12.094

Cited by 15 publications

(4 citation statements)

References 39 publications

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“…There are also some literature reports on the cadaver study using the EEA for clipping intracranial aneurysms. [30][31][32][33][34][35][36][37][38][39][40][41] Many previous articles on cadaver studies have suggested that ACoA aneurysms can be clipped through the EEA, but Montaser et al 32 did not fully agree. To further analyze the clipping of ACoA aneurysms by this approach, we first simulated the approach with a cadaver head.…”

Section: Discussionmentioning

confidence: 99%

“…In previous cadaver studies, Lei et al 30 believed that if the ACoA complex was positioned more posteriorly in relation to the optic chiasm, aneurysm clipping would be difficult to successfully finish through the EEA. Unnithan et al 38 also believed that the aneurysm clip could overlie the optic chiasm, causing undue pressure and mass effects, which could potentially result in compromised vision. We found from the cadaver studies that the optic chiasm was very close to the blood vessels, and we were able to successfully place the clip onto the ACoA complex.…”

Section: Discussionmentioning

confidence: 99%

“…In general, there are not many cases, only 29, and in these limited cases, ACoA aneurysm is not a high proportion. There are also some literature reports on the cadaver study using the EEA for clipping intracranial aneurysms 30–41 . Many previous articles on cadaver studies have suggested that ACoA aneurysms can be clipped through the EEA, but Montaser et al 32 did not fully agree.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Endonasal Approach for Clipping Anterior Communicating Artery Aneurysms From Cadaver Studies and Three-Dimensional Printed Models to a Clinical Case

Qin

Guo

Zheng

et al. 2021

Journal of Craniofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic Endonasal Approach for Clipping Anterior Communicating Artery Aneurysms From Cadaver Studies and Three-Dimensional Printed Models to a Clinical Case

Qin

Guo

Zheng

et al. 2021

Journal of Craniofacial Surgery

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“…These bones articulate and interact with each other through a series of capsular–ligamentous and muscular structures, which characterize the CVJ as the most mobile joint. It also contains the delicate central nervous system (CNS) cervical–medullary junction transition region [ 7 , 8 ].…”

Section: Anatomy and Biomechanicsmentioning

confidence: 99%

Craniovertebral Junction Instability after Oncological Resection: A Narrative Review

et al. 2023

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The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the anatomy, biomechanics and pathology of the craniovertebral junction and to describe the available surgical approaches to and considerations of joint instability after craniovertebral tumor resections. Although a one-size-fits-all approach cannot encompass the extremely challenging pathologies encountered in the CVJ area, including the possible mechanical instability that is a consequence of oncological resections, the optimal surgical strategy (anterior vs posterior vs posterolateral) tailored to the patient’s needs can be assessed preoperatively in many instances. Preserving the intrinsic and extrinsic ligaments, principally the transverse ligament, and the bony structures, namely the C1 anterior arch and occipital condyle, ensures spinal stability in most of the cases. Conversely, in situations that require the removal of those structures, or in cases where they are disrupted by the tumor, a thorough clinical and radiological assessment is needed to timely detect any instability and to plan a surgical stabilization procedure. We hope that this review will help shed light on the current evidence and pave the way for future studies on this topic.

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Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Lemos-Rodriguez

Farzal

Overton

et al. 2018

Int Forum Allergy Rhinol

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Background:The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA). Methods:Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and a er each maneuver.Results: Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal-rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. A er EOM control, mean caudal-rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral-caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal-rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001). Conclusion:Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required. C 2018 ARS-AAOA, LLC. Key Words: orbital/ocular; endoscopy; endoscopic minimally invasive surgery of the skull base; FESS; endoscopic skull base surgery How to Cite this Article: Lemos-Rodriguez AM, Farzal Z, Overton LJ, et al. Analysis of anterior and posterior maneuvers to enhance intraconal exposure. Int Forum Allergy Rhinol. 2019;9:556-561. E ndoscopic endonasal approaches have evolved through the years, from the resection of pituitary and transsellar

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The Expanded Endoscopic Endonasal Approach to Anterior Communicating Artery Aneurysms: A Cadaveric Morphometric Study

Cited by 15 publications

References 39 publications

Endoscopic Endonasal Approach for Clipping Anterior Communicating Artery Aneurysms From Cadaver Studies and Three-Dimensional Printed Models to a Clinical Case

Endoscopic Endonasal Approach for Clipping Anterior Communicating Artery Aneurysms From Cadaver Studies and Three-Dimensional Printed Models to a Clinical Case

Craniovertebral Junction Instability after Oncological Resection: A Narrative Review

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

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