PMID- 29932384
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240521
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 130
IP  - 6
DP  - 2018 Jun 22
TI  - Assessment of the endoscopic endonasal approach to the basilar apex region for 
      aneurysm clipping.
PG  - 1937-1948
LID - 10.3171/2018.1.JNS172813 [doi]
AB  - OBJECTIVE: The 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. METHODS: Fifteen 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. RESULTS: Except 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. CONCLUSIONS: For 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).
FAU - Tayebi Meybodi, Ali
AU  - Tayebi Meybodi A
AD  - 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, 
      Arizona; and.
FAU - Benet, Arnau
AU  - Benet A
AD  - 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, 
      Arizona; and.
FAU - Vigo, Vera
AU  - Vigo V
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Rodriguez Rubio, Roberto
AU  - Rodriguez Rubio R
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Yousef, Sonia
AU  - Yousef S
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Mokhtari, Pooneh
AU  - Mokhtari P
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Dones, Flavia
AU  - Dones F
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Kakaizada, Sofia
AU  - Kakaizada S
AD  - 2Skull Base and Cerebrovascular Laboratory, University of California, San 
      Francisco, California.
FAU - Lawton, Michael T
AU  - Lawton MT
AD  - 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, 
      Arizona; and.
LA  - eng
GR  - TL4 GM118986/GM/NIGMS NIH HHS/United States
PT  - Journal Article
DEP - 20180622
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
PMC - PMC6746604
MID - NIHMS1043438
OTO - NOTNLM
OT  - endoscopic transclival approach
OT  - interpeduncular cistern
OT  - orbitozygomatic approach
OT  - panhypopituitarism
OT  - paraclival internal carotid artery
OT  - pituitary transposition
OT  - vascular disorders
EDAT- 2018/06/23 06:00
MHDA- 2018/06/23 06:01
PMCR- 2019/12/01
CRDT- 2018/06/23 06:00
PHST- 2017/11/07 00:00 [received]
PHST- 2018/01/04 00:00 [accepted]
PHST- 2018/06/23 06:01 [medline]
PHST- 2018/06/23 06:00 [pubmed]
PHST- 2018/06/23 06:00 [entrez]
PHST- 2019/12/01 00:00 [pmc-release]
AID - 2018.1.JNS172813 [pii]
AID - 10.3171/2018.1.JNS172813 [doi]
PST - epublish
SO  - J Neurosurg. 2018 Jun 22;130(6):1937-1948. doi: 10.3171/2018.1.JNS172813.