The management of cerebral aneurysms continues to evolve as a result of the on going search for safer and more effective treatment options. The significant advancement in the endoscopic endonasal techniques has encouraged neurosurgeons to utilize the extended endoscopic endonasal approach (EEA) for cerebral aneurysm clipping [1,2]. Initially, the endoscope was used primarily as an adjunct to the microscope to clip cerebral aneurysm via craniotomy and it has been found as a safe and effective tool for better visualization of cerebrovascular branch points and for better exposure around the aneurysm [3]. EEA to the skull base is a growing technique with promising results in the treatment of many skull base pathologies. It has been showed that extended endoscopic endonasal approaches offer the likelihood of exposing the entire midline skull base from below to reach the brain with its surrounding neu¬rovascular structures [4]. When applied to vascular surgery, the EEA offers some benefits due to the properties of the endoscope itself and minimal invasiveness of technique like lack of brain retraction, direct access to the aneurysm, minimal manipulation of the complex neurovascular structures, better exposure “around the aneurysm”, a close and detailed visualization of the neurovascular structures and to be sure of full exclusion of the aneurysm from the main cerebral circulation, avoidance of skin incisions and a more comfortable postoperative recovery [2,5]. For well-selected cases, this minimally invasive approach may provide a better visualization of the operative field, an equivalent vascular control and direct access to the aneurysm and parent artery, easy access to proximal internal carotid artery control without another incision, no brain parenchyma or any other neurovascular structures between the surgeon and the aneurysm leading to direct surgical corridor compared to transcranial approaches [2,5].

References

1. Xiao LM., et al. “The Endoscopic endonasal clipping of anterior circulation aneurysm: surgical techniques and results”. World Neurosurgery (2018).
2. Kumar A., et al. “The Endoscopic endonasal clipping of cerebral aneurysms: started from the bottom, now we here”. Journal of Neurosurgical Sciences (2018).
3. Peris-Celda M., et al. “The Surgical anatomy of endoscope-assisted approaches to common aneurysm sites”. Neurosurgery 10.1 (2014): 121-144. 
4. Cavallo LM., et al. “The Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations”. Neurosurgical Focus 19.1 (2005): E2.
5. Di Somma A., et al. “The Extended endoscopic endonasal approaches for cerebral aneurysms: anatomical, virtual reality and morphometric study”. Biomed Research International (2014): 703-792. 
6. Kassam AB., et al. “The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report”. Neurosurgery 59.1-1 (2006). 

Citation

Citation: Anil Kumar. “Extended Endoscopic Endonasal Approach for Cerebral Aneurysm: What we Know Today”.Acta Scientific Neurology 3.2 (2020): 22-23.

Copyright

Copyright: © 2020 Anil Kumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.