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

OBJECTIVEThe 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.METHODSFifteen 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.RESULTSExcept 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.CONCLUSIONSFor 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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Extracapsular Pituitary Macroadenoma Resection and Internal Carotid Artery Aneurysm Clipping via Endoscopic Endonasal Approach: Technical Description

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633769 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Javier Ospina ◽

Arif Janjua ◽

Peter Gooderham

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Pituitary Macroadenoma ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Aneurysm Clipping ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

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Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

The Journal of Laryngology & Otology ◽

10.1017/s0022215109992271 ◽

2009 ◽

Vol 124 (7) ◽

pp. 816-819 ◽

Cited By ~ 5

Author(s):

P Puraviappan ◽

I P Tang ◽

D J Yong ◽

N Prepageran ◽

R L Carrau ◽

...

Keyword(s):

Spinal Stenosis ◽

Case Reports ◽

Cord Compression ◽

Upper Cervical Spine ◽

Surgical Trauma ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Upper Cervical ◽

Bulbar Dysfunction

AbstractBackground:Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.Aim:We report two patients presenting with spinal stenosis and cord compression secondary to cranio-vertebral tuberculosis, who were successfully decompressed via an endoscopic, endonasal approach.Study design:Two case reports.Methods and results:Both patients were successfully decompressed via an endoscopic, endonasal approach which provided access to the cranio-vertebral junction and upper cervical spine.Conclusion:An endoscopic, endonasal approach is feasible for the surgical management of cranio-vertebral junction stenosis; such an approach minimises surgical trauma to critical structures, reducing post-operative morbidity and the duration of hospital stay.

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Endoscopic Endonasal Approach for Resection of Suprasellar Hemangioblastoma: Selective Pituitary Sacrifice and Use of Indocyanine Dye: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa250 ◽

2020 ◽

Vol 20 (1) ◽

pp. E46-E47 ◽

Cited By ~ 1

Author(s):

Kumar Abhinav ◽

Patricio Gimenez ◽

Matthew Tyler ◽

Zara M Patel ◽

Juan C Fernandez-Miranda

Keyword(s):

Blood Supply ◽

Third Ventricle ◽

Cerebral Arteries ◽

Optic Chiasm ◽

Visual Pathways ◽

Pituitary Function ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Feeding Vessels

Abstract Suprasellar hemangioblastomas are rare lesions occurring sporadically or more commonly with von Hippel Lindau disease (VHLD).1,2 A 27-yr-old female presented with amenorrhea, mildly raised prolactin levels and otherwise normal pituitary function, homonymous hemianopia, and mild cognitive decline. Imaging revealed a large suprasellar lesion arising from the infundibulum, causing compression of optic chiasm with edema in the visual pathways. Lesion appeared hypervascular with prominent feeding vessels from the internal carotid arteries bilaterally. To access these vessels derived from the superior hypophyseal arteries and allow early devascularization, endoscopic endonasal approach was performed.3 Stalk preservation was deemed unlikely. After opening of the suprasellar dura, indocyanine dye allowed early identification of the feeding vessels. They were sequentially sacrificed, allowing early devascularization while preserving the normal blood supply to the optic chiasm from the superior hypophyseal arteries. Pituitary gland and stalk were removed with the latter being completely involved by tumor to provide access to the retroclival region and posterior circulation. After opening of the dura underlying the dorsum sella, inferior pole of the tumor was exposed with blood supply identified from the posterior communicating arteries but not the basilar or posterior cerebral arteries. Devascularized lesion was safely removed from the optic apparatus, hypothalamus, and the third ventricle. Histology was consistent with hemangoblastoma (VHLD negative). Patient's cognitive and visual function normalized with a postoperative magnetic resonance imagingdemonstrating complete resection, no ischemic events on diffusion-weighted imaging, and resolution of the edema in the hypothalamus and visual pathways.1 She was started on desmopressin and replacement therapy for pituitary function. The patient consented to the procedure. Patient provided consent for publication.

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