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Combined endoscopic endonasal and transcranial approach for internal carotid artery aneurysms: usefulness and safety of endonasal proximal control

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Abstract

It is necessary to secure both the proximal and distal sides of the parent artery to prevent premature rupture when clipping cerebral aneurysms. Herein, we describe four cases in which the proximal internal carotid artery (ICA), affected by a paraclinoid aneurysm, was secured using an endoscopic endonasal approach. We used various tools, including a surgical video, cadaver dissection picture, artist’s illustration, and intraoperative photographs, to elucidate the process. No patient experienced postoperative complications at our institution. Compared to the cervical or cavernous ICA, the ICA adjacent to the clivus (paraclival ICA) can be anatomically safely and easily exposed using an endoscopic endonasal approach because there is no need to consider cerebrospinal fluid leakage or hemorrhage from the cavernous sinus. Securing the proximal side of the parent artery using an endoscopic endonasal approach may be a viable method for clipping selected ICA aneurysms, such as paraclinoid aneurysms especially for upward or outward aneurysms of the C2 portion.

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Data availability

The data that support the findings of this study are available from the corresponding author, Takeshi Mikami, upon reasonable request.

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Acknowledgements

We would like to thank Yasuhiro Higuchi, Surgical Training Center of Sapporo Medical University, for technical assistance.

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Author notes

  1. Yukinori Akiyama contributed equally to first author.

Authors and Affiliations

  1. Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan

    Ryota Sato, Yukinori Akiyama, Takeshi Mikami, Chie Kamada, Yusuke Kimura, Katsuya Komatsu & Nobuhiro Mikuni

  2. Department of Neurology, Sapporo Medical University, Sapporo, Hokkaido, Japan

    Yuka Kawata

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  1. Ryota Sato
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by RS, YA, TM, YK, CK, YK, and KK. The first draft of the manuscript was written by RS, YA, and TM. NM commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Takeshi Mikami.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sapporo Medical University (No. 292–3036).

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Patients signed informed consent regarding publishing their data and photographs.

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The authors declare no competing interests.

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Sato, R., Akiyama, Y., Mikami, T. et al. Combined endoscopic endonasal and transcranial approach for internal carotid artery aneurysms: usefulness and safety of endonasal proximal control. Neurosurg Rev 46, 283 (2023). https://doi.org/10.1007/s10143-023-02180-4

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  • DOI: https://doi.org/10.1007/s10143-023-02180-4

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