A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery
| Autor: | Kornkiat Snidvongs, June X.Z. Huang, Rohan McLachlan, Joanne Malek, Richard J. Harvey, Leon T. Lai, Michael K. Morgan, Matthew Lam, David Chin |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
medicine.medical_specialty Endoscopic endonasal surgery Sphenoid Sinus Turbinates Neurosurgical Procedures Cadaver Physiology (medical) medicine.artery medicine Basilar artery Humans Foramen Magnum Superior cerebellar artery Skull Base Foramen magnum medicine.diagnostic_test business.industry Endoscopy General Medicine Anatomy Cerebral Arteries medicine.anatomical_structure Neurology Basilar Artery cardiovascular system Surgery Neurology (clinical) Radiology Dura Mater Nasal Cavity business Cadaveric spasm Cerebellar artery Craniotomy |
| Zdroj: | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 20(4) |
| ISSN: | 1532-2653 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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