A Cadaveric Anatomical Study on Anterior Communicating Artery Aneurysm Surgery by Extended Endoscopic Endonasal Approach

BACKGROUND: The use of minimally invasive approaches in the management of cerebral aneurysms continues to evolve and a purely endoscopic endonasal approach (EEA) for cerebral aneurysm has its own advantages. The purpose of the present study is to perform a detailed anatomical dissection study to test the usefulness of the extended EEAs for selected anterior communicating artery (ACoA) aneurysm. MATERIALS AND METHODS: Nine human cadaveric heads were used for this study, and all dissections were performed through the endonasal corridor. Endoscopic endonasal surgical dissections were carried out, and surgery was simulated in all specimens to reach the ACoA region. The ACoA complex, its neural and osseous relations, degree of vascular exposure, and the ability to perform clip placement were observed and analyzed. RESULTS: The transplanum and transtuberculum approaches exposed the A1 and A2 segments of the anterior cerebral artery and the ACoA in all specimens. This route allowed clip ligation of the distal A1 branches, ACoA and proximal A2 branches to the level of the pericallosal segment. Proximal and distal control was most readily achievable at the level of the ACoA complex. CONCLUSION: The present cadaveric study on nine specimens with bilateral dissection has demonstrated that the endonasal transplanum transtuberculum approach to the ACoA region provides excellent visualization of the vasculature. When selected prudently, such lesions may be favorable targets for an extended endoscopic endonasal (EEA) in comparison to transcranial approaches that may provide a suboptimal exposure.