Using the Endoscopic Endonasal Transclival Approach to Access Aneurysms Arising from AICA, PICA, and Vertebral Artery: An Anatomical Study

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

doi:10.1055/s-0035-1564055

Cited by 10 publications

(7 citation statements)

References 29 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 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%

See 1 more Smart Citation

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%

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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“…26,43 Special endonasal instruments should be designed and used for endoscopic aneurysm surgery. 8,41 Finally, the surgeon should have extensive experience with the EEA before attempting to treat a cerebral aneurysm with this technique. 19,27,40…”

Section: Discussionmentioning

confidence: 99%

“…10,12,13,19,27,41 However, these studies, as well as the few available anatomical studies, have mainly focused on the feasibility of endoscopic surgical access to this region, failing to provide relevant surgical anatomical details and objective evidence on the extent of vascular control over vessels in the BAX region during an EEA. 4,7,8,34,42 Furthermore, no study has compared the EEA with any of the common transcranial approaches to the BAX to provide a clear profile of the relative advantages and limitations of the EEA for treating BAX aneurysms.…”

mentioning

confidence: 99%

Assessment of the endoscopic endonasal approach to the basilar apex region for aneurysm clipping

Meybodi

Benet

Vigo

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The expanded endoscopic endonasal approach (EEA) has shown promising results in treatment of midline skull base lesions. Several case reports exist on the utilization of the EEA for treatment of aneurysms. However, a comparison of this approach with the classic transcranial orbitozygomatic approach to the basilar apex (BAX) region is missing. The present study summarizes the results of a series of cadaveric surgical simulations for assessment of the EEA to the BAX region for aneurysm clipping and its comparison with the transcranial orbitozygomatic approach as one of the most common approaches used to treat BAX aneurysms. METHODS Fifteen cadaveric specimens underwent bilateral orbitozygomatic craniotomies as well as an EEA (first without a pituitary transposition [PT] and then with a PT) to expose the BAX. The following variables were measured, recorded, and compared between the orbitozygomatic approach and the EEA: 1) number of perforating arteries counted on bilateral posterior cerebral arteries (PCAs); 2) exposure and clipping lengths of the PCAs, superior cerebellar arteries (SCAs), and proximal basilar artery; and 3) surgical area of exposure in the BAX region. RESULTS Except for the proximal basilar artery exposure and clipping, the orbitozygomatic approach provided statistically significantly greater values for vascular exposure and control in the BAX region (i.e., exposure and clipping of ipsilateral and contralateral SCAs and PCAs). The EEA with PT was significantly better in exposing and clipping bilateral PCAs compared to EEA without a PT, but not in terms of other measured variables. The surgical area of exposure and PCA perforator counts were not significantly different between the 3 approaches. The EEA provided better exposure and control if the BAX was located ≥ 4 mm inferior to the dorsum sellae. CONCLUSIONS For BAX aneurysms located in the retrosellar area, PT is usually required to obtain improved exposure and control for the bilateral PCAs. However, the transcranial approach is generally superior to both endoscopic approaches for accessing the BAX region. Considering the superior exposure of the proximal basilar artery obtained with the EEA, it could be a viable option when surgical treatment is considered for a low-lying BAX or mid-basilar trunk aneurysms (≥ 4 mm inferior to dorsum sellae).

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“…Endoscopic endonasal approaches have evolved through the years, from the resection of pituitary and transsellar lesions with extension posteriorly to the posterior clinoid and foramen magnum, to the resection of more complex lesions in close proximity to the internal carotid artery (ICA) and/or adjacent neural and vascular structures . Expanded endoscopic approaches have also advanced with the development of new techniques to include medial approaches to the orbit.…”

mentioning

confidence: 99%

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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Using the Endoscopic Endonasal Transclival Approach to Access Aneurysms Arising from AICA, PICA, and Vertebral Artery: An Anatomical Study

Cited by 10 publications

References 29 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

Assessment of the endoscopic endonasal approach to the basilar apex region for aneurysm clipping

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

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