A New Window for the Treatment of Posterior Cerebral Artery, Superior Cerebellar Artery, and Basilar Apex Aneurysm: The Expanded Endoscopic Endonasal Approach

Abstract

Objective: Since the inception of endoscopic skull base surgery, it has continued to evolve through the advent of new technology and surgical corridors. Currently, the expanded endoscopic endonasal approach has given us access to areas of the skull base previously thought not to be approachable through an endonasal technique. Basilar apex aneurysms are the most commonly reported aneurysms in the posterior arterial circulation and have been associated with a higher risk of bleeding, mortality, and morbidity than seen in other locations. In addition, superior cerebellar and posterior cerebral artery aneurysms are seen less frequently, but they can be associated with basilar apex aneurysms. Different surgical approaches and endovascular interventions have been described for the management of these aneurysms, but they can sometimes be associated with high clinical morbidity. The goal of this is study was to explore the feasibility of an endoscopic endonasal transclival approach to treat aneurysms arising in these vessels.