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J Neurol Surg B Skull Base 2013; 74(06): 386-392
DOI: 10.1055/s-0033-1347370
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Transplanum Approach to the Paraclinoid Internal Carotid Artery

Leon T. Lai
1   Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
,
Michael K. Morgan
1   Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
,
Kornkiat Snidvongs
1   Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
,
David C. W. Chin
3   Department of Rhinology, Changi General Hospital, Singapore
,
Ray Sacks
1   Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
,
Richard J. Harvey
1   Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
2   Department of Neurosurgery, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

28. August 2012

04. März 2013

Publikationsdatum:
20. Juni 2013 (online)

    Lizenzen und Reprints

Abstract

Objective To investigate the relevance of an endoscopic transnasal approach to the surgical treatment of paraophthalmic aneurysms.

Setting Binasal endoscopic transplanum surgery was performed.

Participants Seven cadaver heads were studied.

Main Outcome Measures (1) Dimensions of the endonasal corridor, including the operative field depth, lateral limits, and the transplanum craniotomy. (2) The degree of vascular exposure. (3) Surgical maneuverability and access for clip placements.

Results The mean operative depth was 90 ± 4 mm. The lateral corridors were limited proximally by the alar rim openings (29 ± 4 mm) and distally by the distance between the opticocarotid recesses (19 ± 2 mm). The mean posteroanterior distance and width of the transplanum craniotomy were 19 ± 2 mm and 17 ± 3 mm, respectively. Vascular exposure was achieved in 100% of cases for the clinoidal internal carotid artery (ICA), ophthalmic artery, superior hypophyseal artery, and the proximal ophthalmic ICA. Surgical access and clip placement was achieved in 97.6% of cases for vessels located anterior to the pituitary stalk (odds ratio [OR] 73.8; 95% confidence interval [CI] 7.66 to 710.8; p = 0.00).

Conclusion The endoscopic transnasal approach provides excellent visualization of the paraclinoid region vasculature and offers potential surgical alternative for paraclinoid aneurysms.

Keywords

endoscopic endonasal approach - ophthalmic artery aneurysm - superior hypophyseal artery aneurysm - paraclinoid aneurysm - paraophthalmic aneurysm
 

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