Sampath Somanna1, R Arun Babu2, Dwarakanath Srinivas2, Kannepalli V L Narasinga Rao2, Vikas Vazhayil2. 1. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India. sampath.somanna@gmail.com. 2. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
Abstract
BACKGROUND: Transcranial clipping of most posterior circulation aneurysms is one of the most difficult procedures, with high morbidity, and endovascular coiling is an alternative with less risk, but is not devoid of complications and not suitable for all aneurysms. Here we describe four cases of posterior circulation aneurysms clipped via the extended endoscopic endonasal transclival route. To the best of our knowledge, this is the first report of basilar top and posterior cerebral artery aneurysms being clipped endonasally. METHODS AND RESULTS: Four patients with posterior circulation aneurysms underwent extended endoscopic endonasal transclival clipping of the aneurysm. The age range was 35-70 years. There were two males and two females. Three of the four patients presented after the rupture of aneurysms, and the other patient presented with sudden-onset left hemiparesis probably due to thromboembolism from a large unruptured left posterior cerebral artery (PCA) aneurysm. On evaluation with four-vessel digital subtraction angiography (DSA), two patients had a basilar apex aneurysm, one had a basilar trunk aneurysm, and the other had a PCA (P1) aneurysm. Postoperatively, two patients had good recovery. One patient with a PCA aneurysm and another with a basilar apex aneurysm had fresh postoperative deficits. One patient developed postoperative CSF rhinorrhea. CONCLUSION: Endoscopic extended transnasal surgery is an expanding field in neurosurgery with a steep learning curve. With improvement in techniques and instrumentation the use of this approach for clipping posterior circulation aneurysms can become an effective alternative in the treatment of aneurysms.
BACKGROUND: Transcranial clipping of most posterior circulation aneurysms is one of the most difficult procedures, with high morbidity, and endovascular coiling is an alternative with less risk, but is not devoid of complications and not suitable for all aneurysms. Here we describe four cases of posterior circulation aneurysms clipped via the extended endoscopic endonasal transclival route. To the best of our knowledge, this is the first report of basilar top and posterior cerebral artery aneurysms being clipped endonasally. METHODS AND RESULTS: Four patients with posterior circulation aneurysms underwent extended endoscopic endonasal transclival clipping of the aneurysm. The age range was 35-70 years. There were two males and two females. Three of the four patients presented after the rupture of aneurysms, and the other patient presented with sudden-onset left hemiparesis probably due to thromboembolism from a large unruptured left posterior cerebral artery (PCA) aneurysm. On evaluation with four-vessel digital subtraction angiography (DSA), two patients had a basilar apex aneurysm, one had a basilar trunk aneurysm, and the other had a PCA (P1) aneurysm. Postoperatively, two patients had good recovery. One patient with a PCA aneurysm and another with a basilar apex aneurysm had fresh postoperative deficits. One patient developed postoperative CSF rhinorrhea. CONCLUSION: Endoscopic extended transnasal surgery is an expanding field in neurosurgery with a steep learning curve. With improvement in techniques and instrumentation the use of this approach for clipping posterior circulation aneurysms can become an effective alternative in the treatment of aneurysms.
Authors: Nathan T Zwagerman; Georgios Zenonos; Stefan Lieber; Wei-Hsin Wang; Eric W Wang; Juan C Fernandez-Miranda; Carl H Snyderman; Paul A Gardner Journal: J Neurooncol Date: 2016-10-20 Impact factor: 4.130
Authors: Francesco Belotti; Francesco Tengattini; Davide Mattavelli; Marco Ferrari; Antonio Fiorentino; Silvia Agnelli; Alberto Schreiber; Piero Nicolai; Marco Maria Fontanella; Francesco Doglietto Journal: Neurosurg Rev Date: 2020-02-14 Impact factor: 3.042