Turkish Neurosurgery
Anatomical assessment of the endoscopic assisted lateral supraorbital approach and endoscopic endonasal transclival approach to basilar apex aneurysms
Elena d\'Avella1, Benedetta Fazzolari2, Martina Cappelletti3, Alberto Delitala4, Domenico Solari1, Teresa Somma1, Luigi Maria Cavallo1, Alberto Prats-Galino5
1Università degli studi di Napoli Federico II, Neurosurgery, Naples,
2Santa Maria Goretti Hospital, Neurosurgery, Latina,
3Padova University, Treviso Regional Hospital, Neurosurgery, Treviso,
4“San Camillo Forlanini” Hospital, Neurosurgery, Rome,
55Laboratory of Surgical Neuroanatomy, University of Barcelona, Faculty of Medicine, Barcelona,
DOI: 10.5137/1019-5149.JTN.28775-19.2

Aim:The aim of this study is to assess the feasibility of the endoscopic assisted lateral supraorbital (LSO) approach and the endoscopic endonasal transclival approach (EETA) for basilar apex (BAX) aneurysms.Material and Methods:Ten LSO approaches, with or without posterior clinoidectomy (pc) and endoscopic assistance, and ten EETA, with or without drilling of dorsum sellae (dds), were performed on twenty cadaveric heads. Anatomical exposure (AE) and surgical freedom (SF) at the BAX were evaluated. Results:AE provided by LSO approach was limited to BAX and ipsilateral PCA and increased of a mean value of 5mm after pc; basilar artery, contralateral PCA and SCAs were visualized in all cases. SF accordingly was larger. Endoscopic assistance provided a significant increase in BA exposure; SF did not increase as much. The main advantage of EETA was the greatest exposure of BA. With dds, AE increased for a mean value of 3,4mm, with the widest SF and visualization of BA terminal bifurcation and SCAs in all cases. Conclusion:The endoscopic assisted LSO approach and the EETA may represent a feasible option for the treatment of BAX aneurysms lying within 5mm below the dorsum sellae and not higher than 3,4 mm from it, respectively.

Corresponding author : Elena d\'Avella