A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery

Leon T. Lai*, Michael K. Morgan, David C W Chin, Kornkiat Snidvongs, June X Z Huang, Joanne Malek, Matthew Lam, Rohan McLachlan, Richard J. Harvey

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    17 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)587-592
    Number of pages6
    JournalJournal of Clinical Neuroscience
    Volume20
    Issue number4
    DOIs
    Publication statusPublished - Apr 2013

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