A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery

被引:17
|
作者
Lai, Leon T. [1 ]
Morgan, Michael K. [1 ]
Chin, David C. W. [3 ]
Snidvongs, Kornkiat [1 ]
Huang, June X. Z. [2 ]
Malek, Joanne [2 ]
Lam, Matthew [2 ]
McLachlan, Rohan [2 ]
Harvey, Richard J. [2 ]
机构
[1] Macquarie Univ, Australian Sch Adv Med, N Ryde, NSW 2109, Australia
[2] Univ New S Wales, Kensington, NSW 2033, Australia
[3] Changi Gen Hosp, Singapore, Singapore
关键词
Basilar artery; Endonasal; Endoscopy; Intracranial aneurysm; Transclival; SKULL BASE SURGERY; TRANSSPHENOIDAL APPROACH; ANEURYSM; RESECTION; JUNCTION; REPAIR; RECONSTRUCTION; COMPLICATIONS; MANAGEMENT; EVOLUTION;
D O I
10.1016/j.jocn.2012.03.042
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The anterior transclival route to basilar artery aneurysms is not widely performed. The objective of this study was to carry out a feasibility assessment of the transclival approach to basilar aneurysms with advanced endonasal techniques on 11 cadaver heads. Clival dura was exposed from the sella to the foramen magnum between the paraclival segments of the internal carotid arteries (ICA) laterally. An inverted dural "U" flap was reflected inferiorly to expose the basilar artery. The maximal dimensions from operative measurements were recorded. Surgical manoeuvrability of multiple instruments and the proficiency to place proximal and distal vascular clips were evaluated. The mean operative depth (+/- standard deviation), measured from the anterior choanae to the basilar artery, was 110 +/- 6 mm. The lateral corridors were limited distally by the medial pterygoids (mean width 21 +/- 2 mm) and paraclival ICA (mean width 20 2 mm). The mean transclival craniectomy dimensions were 19 +/- 2 mm (width) and 23 +/- 4 mm (height). Exposure of the basilar-anterior inferior cerebellar artery junction, superior cerebellar artery, and the basilar caput were possible in 100%, 91%, and 64% of instances, respectively. Placements of proximal and distal aneurysm clips were achieved in all instances. Based on our findings, the transclival endoscopic endonasal surgery approach provides excellent visualisation of the basilar artery. Clip application and manoeuvrability of instruments was considered adequate for basilar aneurysm surgery. Surgical skills and instrumentation to control significant haemorrhage can potentially limit the clinical applicability of this technique. Crown Copyright (C) 2012 Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:587 / 592
页数:6
相关论文
共 50 条
  • [31] Endoscopic endonasal approach to the nerves of the pterygopalatine fossa: a detailed cadaveric anatomical study
    Hilal Akdemir Aktaş
    Turab Gasimov
    Alberto Acitores Cancela
    Abdullah Keleş
    Mehmet Sabri Gürbüz
    İlkan Tatar
    Mustafa Kemal Başkaya
    Surgical and Radiologic Anatomy, 47 (1)
  • [32] Assessment of the Endoscopic Endonasal Transclival Approach for Surgical Clipping of Anterior Pontine Anterior-Inferior Cerebellar Artery Aneurysms
    Sanmillan, Jose L.
    Lawton, Michael T.
    Rincon-Torroella, Jordina
    El-Sayed, Ivan H.
    Zhang, Xin
    Meybodi, Ali Tayebi
    Gabarros, Andreu
    Benet, Arnau
    WORLD NEUROSURGERY, 2016, 89 : 368 - 375
  • [33] Endoscopic Endonasal Transclival Resection of the Upper Clival Meningioma
    Gunaldi, Omur
    Kina, Hakan
    Tanriverdi, Osman
    Erdogan, Uzay
    Postalci, Lutfi Sinasi
    TURKISH NEUROSURGERY, 2018, 28 (03) : 505 - 509
  • [34] Comparison of the Endoscopic Endonasal Approach with the Endoscopic Supraorbital Keyhole Approach to the Tuberculum Sellae Region: A Quantitatively Cadaveric Study
    Zhu, Junhao
    Cong, Zixiang
    Yang, Jin
    Yuan, Feng
    Cai, Xiangming
    Tang, Chao
    Du, Chaonan
    Feng, Dongxia
    Ma, Chiyuan
    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY, 2024, 85 (01) : 7 - 13
  • [35] Extended endoscopic endonasal transclival clipping of posterior circulation aneurysms—an alternative to the transcranial approach
    Sampath Somanna
    R. Arun Babu
    Dwarakanath Srinivas
    Kannepalli V. L. Narasinga Rao
    Vikas Vazhayil
    Acta Neurochirurgica, 2015, 157 : 2077 - 2085
  • [36] The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases
    Prevedello, Daniel M.
    Fernandez-Miranda, Juan Carlos
    Gardner, Paul
    Madhok, Ricky
    Sigounas, Dimitri
    Snyderman, Carl H.
    Carrau, Ricardo L.
    Kassam, Amin B.
    ACTA NEUROCHIRURGICA, 2010, 152 (07) : 1223 - 1229
  • [37] The transclival endoscopic endonasal approach (EEA) for prepontine neuroenteric cysts: report of two cases
    Daniel M. Prevedello
    Juan Carlos Fernandez-Miranda
    Paul Gardner
    Ricky Madhok
    Dimitri Sigounas
    Carl H. Snyderman
    Ricardo L. Carrau
    Amin B. Kassam
    Acta Neurochirurgica, 2010, 152 : 1223 - 1229
  • [38] Human cadaveric study of the morphology of the basilar artery
    Mamatha, Hosapatna
    D'Souza, Antony Sylvan
    Pallavi
    Sumalatha, Suhani
    SINGAPORE MEDICAL JOURNAL, 2012, 53 (11) : 760 - 763
  • [39] Endonasal endoscopic transsphenoidal approach robot prototype: A cadaveric trial
    Chumnanvej, Sorayouth
    Pillai, Branesh M.
    Chalongwongse, Suwiphat
    Suthakorn, Jackrit
    ASIAN JOURNAL OF SURGERY, 2021, 44 (01) : 345 - 351
  • [40] Extended endoscopic endonasal transclival clipping of posterior circulation aneurysms—an alternative to the transcranial approach
    Mohamed Labib
    Amir R. Dehdashti
    Acta Neurochirurgica, 2015, 157 : 2087 - 2088