Introduction: Transcranial clipping of most of the posterior circulation aneurysms are one of the most difficult procedures with high morbidity and endovascular coiling is an alternative with less risk but is not devoid of complications and is not suitable for all aneurysms. Here we describe four cases of posterior circulation aneurysms clipped via extended endoscopic endonasal transclival route. To best of our knowledge this is the first report of basilar top and posterior cerebral artery aneurysms being clipped endonasally.
Methods: The age range was between 35 and 70 years. There were 2 males and 2 females. Three out of four patients had presented after the rupture of aneurysms and the other patient presented with sudden onset left hemiparesis probably due to thromboembolism from a large unruptured left posterior cerebral artery (PCA) aneurysm. On evaluation with 4 vessel digital subtraction angiography (DSA), 2 patients had basilar apex aneurysm, 1 patient had basilar trunk aneurysm and the other patient had posterior cerebral artery aneurysm. All the patients underwent extended endoscopic endonasal transclival clipping of the aneurysm.
Results: . Post operatively two patients had good recovery. One patient with PCA aneurysm and the other patient with basilar apex aneurysm had fresh post-operative deficits. One patient developed post-operative CSF rhinorrhea.Another patien t was reexplored because of malposition of clip.
Conclusions: Endoscopic extended transnasal surgery is an expanding field in neurosurgery with a steep learning curve. With improvement in techniques and instrumentation the use of this approach for clipping posterior circulation aneurysms can become an effective alternative in the treatment of aneurysms.
Patient Care: Another approach to learn as it is cosmaticaly excellent
Learning Objectives: New approach