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J Neurol Surg B Skull Base 2017; 78(03): 235-244
DOI: 10.1055/s-0036-1597278
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

Jeremy N. Ciporen   *
1   Department of Neurological Surgery, Center for Health and Healing, Oregon Health & Science University, Portland, Oregon, United States
,
Brandon Lucke-Wold   *
2   Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
,
Aclan Dogan
1   Department of Neurological Surgery, Center for Health and Healing, Oregon Health & Science University, Portland, Oregon, United States
,
Justin Cetas
1   Department of Neurological Surgery, Center for Health and Healing, Oregon Health & Science University, Portland, Oregon, United States
,
William Cameron
3   Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, United States
› Author Affiliations
Further Information

Publication History

31 March 2016

23 October 2016

Publication Date:
22 December 2016 (online)

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Abstract

Purpose Simulation training offers a useful opportunity to appreciate vascular anatomy and develop the technical expertise required to clip intracranial aneurysms of the posterior circulation.

Materials and Methods In cadavers, a comparison was made between the endoscopic transclival approach (ETA) alone and a combined multiportal approach using the ETA and a transorbital precaruncular approach (TOPA) to evaluate degrees of freedom, angles of visualization, and ergonomics of aneurysm clip application to the posterior circulation depending on basilar apex position relative to the posterior clinoids.

Results ETA alone provided improved access to the posterior circulation when the basilar apex was high riding compared with the posterior clinoids. ETA + TOPA provided a significantly improved functional working area for instruments and visualization of the posterior circulation for a midlevel basilar apex. A single-shaft clip applier provided improved visualization and space for instruments. Proximal and distal vascular control and feasibility of aneurysmal clipping were demonstrated.

Conclusions TOPA is a medial orbital approach to the central skull base; a transorbital neuroendoscopic surgery approach. This anatomical simulation provides surgical teams an alternative to the ETA approach alone to address posterior circulation aneurysms, and a means to preoperatively prepare for intraoperative anatomical and surgical instrumentation challenges.

Keywords

posterior circulation aneurysms - endoscopic approach - endonasal transclival approach - transorbital neuroendoscopic surgery - simulation training

* Denotes equal contribution for first author.


 

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