Download PDF
J Neurol Surg B Skull Base 2016; 77(03): 207-211
DOI: 10.1055/s-0035-1564055
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Vivian Doan
1   Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Ana M. Lemos-Rodriguez
2   Department of Ear, Nose, and Throat Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Satyan B. Sreenath
2   Department of Ear, Nose, and Throat Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Ajay Unnithan
1   Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Pablo F. Recinos
3   Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, United States
,
Adam M. Zanation
2   Department of Ear, Nose, and Throat Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
,
Deanna M. Sasaki-Adams
1   Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
› Author Affiliations
Further Information

Publication History

13 March 2015

22 July 2015

Publication Date:
08 October 2015 (online)

    Permissions and Reprints

Abstract

Objective To explore the use of the endoscopic endonasal transclival approach (EEA) for clipping anterior inferior cerebellar artery (AICA), posterior inferior cerebellar artery (PICA), and vertebral artery (VA) aneurysms.

Design Anatomical study.

Participants Fifteen adult cadavers.

Main Outcome Measures Length of artery exposed and distance from the nasal ala to the arteries.

Results The length of the right and left VA exposed were 1.7 ± 0.6 cm and 1.6 ± 0.6 cm, respectively. The distance to the right VA was 11.1 ± 0.9 cm and to the left was 11.1 ± 0.8 cm. Right and left AICA were exposed for an average length of 1.1 ± 0.3 cm and 0.8 ± 0.3 cm, respectively. The distance to the right AICA was 10.3 ± 0.8 cm and to the left was 10.3 ± 0.8 cm. The right PICA was exposed for a length of 0.5 ± 0.2 cm at a distance of 10.9 ± 0.5 cm. The left PICA was exposed for a length of 0.5 ± 0.2 cm at a distance of 11.1 ± 0.9 cm.

Conclusion The EEA can provide direct access to AICA, PICA, and VA, making it a potential alternative to the traditional approaches for the clipping of aneurysms arising from those arteries.

Keywords

aneurysms - endoscopic endonasal - surgical clipping - transclival
 

  • References

  • 1 Cavallo LM, Messina A, Cappabianca P , et al. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 2005; 19 (1) E2
    PubMedGoogle Scholar
  • 2 Drazin D, Zhuang L, Schievink WI, Mamelak AN. Expanded endonasal approach for the clipping of a ruptured basilar aneurysm and feeding artery to a cerebellar arteriovenous malformation. J Clin Neurosci 2012; 19 (1) 144-148
    CrossrefPubMedGoogle Scholar
  • 3 Enseñat J, Alobid I, de Notaris M , et al. Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report. Neurosurgery 2011; 69 (1, Suppl Operative): E121-E127 ; discussion E127–E128
    PubMedGoogle Scholar
  • 4 Germanwala AV, Zanation AM. Endoscopic endonasal approach for clipping of ruptured and unruptured paraclinoid cerebral aneurysms: case report. Neurosurgery 2011; 68 (1, Suppl Operative): 234-239 ; discussion 240
    PubMedGoogle Scholar
  • 5 Kassam AB, Mintz AH, Gardner PA, Horowitz MB, Carrau RL, Snyderman CH. The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report. Neurosurgery 2006; 59 (1) (Suppl. 01) E162-E165 ; discussion E162–E165
    PubMedGoogle Scholar
  • 6 Lai LT, Morgan MK, Chin DCW , et al. A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery. J Clin Neurosci 2013; 20 (4) 587-592
    CrossrefPubMedGoogle Scholar
  • 7 Schievink WI, Wijdicks EFM, Piepgras DG, Chu CP, O'Fallon WM, Whisnant JP. The poor prognosis of ruptured intracranial aneurysms of the posterior circulation. J Neurosurg 1995; 82 (5) 791-795
    CrossrefPubMedGoogle Scholar
  • 8 Ogilvy CS, Hoh BL, Singer RJ, Putman CM. Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery 2002; 51 (1) 14-21 ; discussion 21–22
    CrossrefPubMedGoogle Scholar
  • 9 Gonzalez LF, Alexander MJ, McDougall CG, Spetzler RF. Anteroinferior cerebellar artery aneurysms: surgical approaches and outcomes—a review of 34 cases. Neurosurgery 2004; 55 (5) 1025-1035
    CrossrefPubMedGoogle Scholar
  • 10 Hudgins RJ, Day AL, Quisling RG, Rhoton Jr AL, Sypert GW, Garcia-Bengochea F. Aneurysms of the posterior inferior cerebellar artery. A clinical and anatomical analysis. J Neurosurg 1983; 58 (3) 381-387
    CrossrefPubMedGoogle Scholar
  • 11 Chalouhi N, Jabbour P, Starke RM , et al. Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms. J Neurosurg 2013; 118 (5) 991-999
    CrossrefPubMedGoogle Scholar
  • 12 Drake CG. The treatment of aneurysms of the posterior circulation. Clin Neurosurg 1979; 26: 96-144
    PubMedGoogle Scholar
  • 13 Molyneux A, Kerr R, Stratton I , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial. . Lancet 2002; 360 (9342) 1267-1274
    CrossrefPubMedGoogle Scholar
  • 14 Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA. Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus 2009; 26 (5) E6
    PubMedGoogle Scholar
  • 15 D'Ambrosio AL, Kreiter KT, Bush CA , et al. Far lateral suboccipital approach for the treatment of proximal posteroinferior cerebellar artery aneurysms: surgical results and long-term outcome. Neurosurgery 2004; 55 (1) 39-50 ; discussion 50–54
    CrossrefPubMedGoogle Scholar
  • 16 Heros RC. Lateral suboccipital approach for vertebral and vertebrobasilar artery lesions. J Neurosurg 1986; 64 (4) 559-562
    CrossrefPubMedGoogle Scholar
  • 17 Krayenbühl N, Guerrero C, Krisht AF. Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries. Neurosurg Focus 2005; 19 (2) E4
    PubMedGoogle Scholar
  • 18 Al-khayat H, Al-Khayat H, Beshay J, Manner D, White J. Vertebral artery-posteroinferior cerebellar artery aneurysms: clinical and lower cranial nerve outcomes in 52 patients. Neurosurgery 2005; 56 (1) 2-10 ; discussion 11
    CrossrefPubMedGoogle Scholar
  • 19 Andoh T, Shirakami S, Nakashima T , et al. Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 1992; 31 (6) 987-993 ; discussion 993
    CrossrefPubMedGoogle Scholar
  • 20 Horowitz M, Kopitnik T, Landreneau F , et al. Posteroinferior cerebellar artery aneurysms: surgical results for 38 patients. Neurosurgery 1998; 43 (5) 1026-1032
    CrossrefPubMedGoogle Scholar
  • 21 Suh SH, Kim DJ, Kim DI , et al. Management of anterior inferior cerebellar artery aneurysms: endovascular treatment and clinical outcome. AJNR Am J Neuroradiol 2011; 32 (1) 159-164
    CrossrefPubMedGoogle Scholar
  • 22 Pandey AS, Koebbe C, Rosenwasser RH, Veznedaroglu E. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery 2007; 60 (4) 626-636 ; discussion 636–637
    PubMedGoogle Scholar
  • 23 Di Somma A, de Notaris M, Stagno V , et al. Extended endoscopic endonasal approaches for cerebral aneurysms: anatomical, virtual reality and morphometric study. Biomed Res Int 2014; 2014: 703792
    PubMedGoogle Scholar
  • 24 Lai LT, Morgan MK, Dalgorf D , et al. Cadaveric study of the endoscopic endonasal transtubercular approach to the anterior communicating artery complex. J Clin Neurosci 2014; 21 (5) 827-832
    CrossrefPubMedGoogle Scholar
  • 25 Kassam AB, Prevedello DM, Carrau RL , et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114 (6) 1544-1568
    CrossrefPubMedGoogle Scholar
  • 26 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar
  • 27 Patel MR, Taylor RJ, Hackman TG , et al. Beyond the nasoseptal flap: outcomes and pearls with secondary flaps in endoscopic endonasal skull base reconstruction. Laryngoscope 2014; 124 (4) 846-852
    CrossrefPubMedGoogle Scholar
  • 28 Heiferman DM, Somasundaram A, Alvarado AJ, Zanation AM, Pittman AL, Germanwala AV. The endonasal approach for treatment of cerebral aneurysms: a critical review of the literature. Clin Neurol Neurosurg 2015; 134: 91-97
    CrossrefPubMedGoogle Scholar