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How I do it: the endoscopic endonasal transclival approach for clipping of the ruptured vertebral artery aneurysm

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Abstract

Background

Vertebral artery aneurysms account for less than 5% of all cerebral aneurysms. They have a high risk of rupture and are associated with threatening clinical outcomes compared with anterior circulation aneurysms.

Method

The endoscopic endonasal transclival approach (EETA) was used. During the temporary clipping, the neck of the aneurysm was dissected, and a permanent clip was applied. The repair of the skull base defect was carried out with the nasoseptal mucoperiosteal flap on the vascular pedicle.

Conclusion

The EETA is a feasible alternative for the clipping of the medially located ruptured vertebral artery aneurysm. EETA can be recommended for centers with a large volume of cerebrovascular and endoscopic neurosurgical procedures.

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Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Author information

Authors and Affiliations

  1. MONIKI M. F. Vladimirskii Moscow Regional Scientific Research Institute, Moscow, Russia

    Revaz Dzhindzhikhadze, Renat Kambiev, Andrey Polyakov & Andrew Zaitsev

  2. Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education”, Moscow, Russia

    Revaz Dzhindzhikhadze & Andrew Zaitsev

Authors
  1. Revaz Dzhindzhikhadze
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  2. Renat Kambiev
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  3. Andrey Polyakov
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  4. Andrew Zaitsev
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Corresponding author

Correspondence to Andrew Zaitsev.

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The authors declare no competing interests.

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Key points

1. Individual selection of patients with medially located VA aneurysms.

2. Individual approach planning using intraoperative neuronavigation.

3. Harvesting the NMF on the vascular pedicle, as well as a bone fragment of the nasal septum, for the subsequent repair of the skull base defect.

4. Performing an EETA.

5. Identification of VA, BA, PICA, and abducens nerves before clipping.

6. Achieving minimal prolapse of permanent clips into the skull base defect.

7. Performing multilayer repair of the skull base defect using an NMF on the vascular pedicle, a bone fragment of the nasal septum, and fibrin-thrombin glue.

Supplementary Information

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Dzhindzhikhadze, R., Kambiev, R., Polyakov, A. et al. How I do it: the endoscopic endonasal transclival approach for clipping of the ruptured vertebral artery aneurysm. Acta Neurochir 165, 2825–2830 (2023). https://doi.org/10.1007/s00701-023-05606-6

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  • DOI: https://doi.org/10.1007/s00701-023-05606-6

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