Document Detail

Endoscopic endonasal approach for clipping of ruptured and unruptured paraclinoid cerebral aneurysms: case report.
MedLine Citation:
PMID:  21206311     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND IMPORTANCE: We present a case in which clip ligation of both a ruptured and an unruptured paraclinoidal segment aneurysm is performed with only the endoscopic endonasal approach in 1 setting.
CLINICAL PRESENTATION: A 42-year-old woman, a Hunt and Hess grade 2 patient, presented with aneurysmal subarachnoid hemorrhage. An arteriogram revealed an irregular 10-mm right paraclinoidal aneurysm projecting posteromedially and a 5-mm wide-necked right ophthalmic artery aneurysm projecting superomedially. The patient was taken to the operating room where clipping of both aneurysms was performed through the use of an endonasal endoscopic approach with a pedicled nasoseptal flap reconstruction. Such an approach allowed excellent visualization without drilling of the clinoid process or mobilization of the optic nerve and potential control of the proximal and distal internal carotid artery. An intraoperative arteriogram showed obliteration of both aneurysms with patency of the surrounding vasculature. The patient did well postoperatively and was subsequently discharged home without any neurological deficits.
CONCLUSION: An endoscopic endonasal approach was immediately safe and effective for the clipping of both paraclinoidal aneurysms. Although there were benefits achieved from this particular unconventional approach, surgical clipping via traditional craniotomy and endovascular coiling are the established methods of aneurysm treatment and should always be primarily considered. More cases will determine the efficacy and safety of this approach, which should be attempted only by very experienced teams trained in both cerebrovascular and endonasal neurosurgery.
Anand V Germanwala; Adam M Zanation
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  68     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-04-11     Completed Date:  2011-06-21     Revised Date:  2011-08-25    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  234-9; discussion 240     Citation Subset:  IM    
Department of General Surgery, Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7060, USA.
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MeSH Terms
Aneurysm, Ruptured / surgery*
Angiography / methods
Endoscopy / methods
Neurosurgical Procedures / instrumentation*,  methods*
Subarachnoid Hemorrhage / complications*
Surgical Instruments*
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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