Endoscopic endonasal clipping of anterior circulation aneurysm: surgical techniques and results.

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Endoscopic endonasal clipping of anterior circulation aneurysm: surgical techniques and results.

World Neurosurg. 2018 Mar 21;:

Authors: Xiao LM, Tang B, Xie SH, Huang GL, Wang ZG, Zeng EM, Hong T

Abstract
OBJECTIVE: Endoscopic endonasal clipping of intracranial aneurysms may utilize the microsurgical techniques as an alternative to the transcranial approach. The aim of this manuscript is to report a series of patients who underwent endoscopic endonasal approach(EEA) for microsurgical clipping of anterior circulation aneurysms.
METHOD: A retrospective chart review was conducted. All the patients who underwent standard binostril EEA for aneurysm clipping were included. Surgical outcome and complications were noted. The rationality and limitations of this procedure were discussed.
RESULTS: Seven patients with 12 aneurysms of anterior circulation underwent EEA for clipping. The aneurysms consisted of 5 anterior communicating artery (Acom) aneurysms, 4 paraclinoid aneurysms, 1 ophthalmic artery aneurysm, and 2 aneurysm located in the cavernous segment of internal carotid artery (ICA). Nine of the twelve aneurysms were successfully clipped. One giant paraclionoid aneurysm could not be clipped during operation and be coiled in second endovascular stage. The 2 aneurysms located in the cavernous segment of ICA were not clipped intentionally in one-stage procedure, after weighing the surgical benefit against the difficulty of surgical exposure and feasibility. The proximal control of ICA was achieved in all cases. There was no death, no CSF leak and other complications. All patients recovered completely.
CONCLUSIONS: EEA can provide direct access for microsurgical clipping of strictly selected anterior circulation aneurysms. All the principles of cerebrovascular surgery have to be followed. These procedures require a long learning curve. Only teams with adequate experience in microvascular and endoscopic skull base surgeries should attempt this approach for treating aneurysms.

PMID: 29574221 [PubMed - as supplied by publisher]

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