Endoscopic endonasal clipping of an unsecured superior hypophyseal artery aneurysm

Technical note

Restricted access

✓Paraclinoidal aneurysms, especially superior hypophyseal artery (SHA) aneurysms (with medial projection), can be challenging to access via a pterional craniotomy and damage to the optic nerve can occur during surgery. The authors have previously reported on endonasal clipping and aneurysmorrhaphy of a vertebral artery aneurysm following proximal and distal protection of the aneurysm using partial coil embolization. To the best of the authors' knowledge no unprotected aneurysm has been clipped using an endonasal approach.

The 56-year-old woman in this report was found to have two unruptured aneurysms: an anterior communicating artery (ACoA) aneurysm and an SHA aneurysm. An endoscopic endonasal, transplanar–transsellar approach was used to successfully clip the SHA aneurysm. Proximal and distal control was obtained endonasally prior to successful clip occlusion of the aneurysm. The ACoA aneurysm was clipped via a pterional craniotomy during the same anesthetic session. This report shows that it is possible to successfully clip a medially projecting, paraclinoidal aneurysm using an endonasal approach. Such cases must be chosen with extreme caution and only performed by surgeons with significant experience with both endoscopic endonasal approaches and neurovascular surgery.

Abbreviations used in this paper:ACoA = anterior communicating artery; CT = computed tomography; ICA = internal carotid artery; SHA = superior hypophyseal artery.
Article Information

Contributor Notes

Address correspondence to: Amin B. Kassam, M.D., Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B400, Pittsburgh, Pennsylvania 15213. email: kassamab@upmc.edu.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Batjer HHKopitnik TAGiller CASamson DS: Surgery for paraclinoidal artery aneurysm. J Neurosurg 80:6506581994

  • 2

    Day AL: Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:6776911990

  • 3

    Hadad GBassagasteguy LCarrau RLMataza JCKassam ASnyderman CH: A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:188218862006

    • Search Google Scholar
    • Export Citation
  • 4

    Heros RCNelson PBOjemann RGCrowell RMDeBrun G: Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 12:1531631983

    • Search Google Scholar
    • Export Citation
  • 5

    Kassam ABMintz AHGardner PAHorowitz MBCarrau RLSnyderman CS: The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report. Neurosurgery 59:1 SupplONSE162ONSE1652006

    • Search Google Scholar
    • Export Citation
  • 6

    Kassam ABSnyderman CHMintz AGardner PCarrau RL: Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19:1E32005

    • Search Google Scholar
    • Export Citation
  • 7

    Kattner KABailes JFukushima T: Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol 49:4714801998

    • Search Google Scholar
    • Export Citation
  • 8

    Kobayashi SKyoshima KGibo HHegde SATakemae TSugita K: Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70:2162211989

    • Search Google Scholar
    • Export Citation
  • 9

    Kumon YSakaki SKohno KOhta SOhue SOka Y: Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol 48:4654721997

    • Search Google Scholar
    • Export Citation
  • 10

    Nagasawa SOhta TTsuda E: Surgical results and the related topographic anatomy in paraclinoid internal artery aneurysms. Neurol Res 18:4014081996

    • Search Google Scholar
    • Export Citation
  • 11

    Rizzo JF: Visual loss after neurosurgical repair of paraclinoid aneurysms. Ophthalmology 102:9059101995

TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 306 303 90
Full Text Views 181 99 3
PDF Downloads 59 36 2
EPUB Downloads 0 0 0
PubMed
Google Scholar