A New Window for the Treatment of Posterior Cerebral Artery, Superior Cerebellar Artery, and Basilar Apex Aneurysm: The Expanded Endoscopic Endonasal Approach

ObjectiveTo explore the feasibility of an endoscopic endonasal transclival approach to treat aneurysms arising in the basilar apex, posterior cerebral arteries, and superior cerebellar arteries. Study DesignCadaveric anatomical study. ParticipantsFifteen cadaveric specimens. Main Outcome MeasuresDegree of surgical exposure of each artery attained, distance from the nasal vestibule to these three arteries, and feasibility of clipping these vessels using standard vascular clip applicators. ResultsBoth posterior cerebral arteries were exposed, 0.67 cm (standard deviation [SD]: 0.2) on the right side and 0.59 cm (SD: 0.2) on the left side. Both right and left superior cerebral arteries were exposed, 0.6 cm (SD: 0.2) and 0.7 cm (SD: 0.3), respectively. The length of the basilar artery exposed was 2.6 cm (SD: 0.3). The distance from the nasal vestibule to the posterior cerebral artery, superior cerebellar artery, and basilar apex was 10 cm with an SD of0.7, 0.6, and 0.8 cm, respectively. We were able to apply clips on each of these three vessels with a minimal alteration of surrounding normal tissue. ConclusionThe endoscopic endonasal transclival approach represents a potentially feasible surgical corridor to treat aneurysms arising from these vessels.