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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery
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A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery

机译：鼻内窥镜经鼻腔入路基底动脉的尸体研究

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The anterior transclival route to basilar artery aneurysms is not widely performed. The objective of this study was to carry out a feasibility assessment of the transclival approach to basilar aneurysms with advanced endonasal techniques on 11 cadaver heads. Clival dura was exposed from the sella to the foramen magnum between the paraclival segments of the internal carotid arteries (ICA) laterally. An inverted dural "U" flap was reflected inferiorly to expose the basilar artery. The maximal dimensions from operative measurements were recorded. Surgical manoeuvrability of multiple instruments and the proficiency to place proximal and distal vascular clips were evaluated. The mean operative depth (± standard deviation), measured from the anterior choanae to the basilar artery, was 110 ± 6 mm. The lateral corridors were limited distally by the medial pterygoids (mean width 21 ± 2 mm) and paraclival ICA (mean width 20 ± 2 mm). The mean transclival craniectomy dimensions were 19 ± 2 mm (width) and 23 ± 4 mm (height). Exposure of the basilar-anterior inferior cerebellar artery junction, superior cerebellar artery, and the basilar caput were possible in 100%, 91%, and 64% of instances, respectively. Placements of proximal and distal aneurysm clips were achieved in all instances. Based on our findings, the transclival endoscopic endonasal surgery approach provides excellent visualisation of the basilar artery. Clip application and manoeuvrability of instruments was considered adequate for basilar aneurysm surgery. Surgical skills and instrumentation to control significant haemorrhage can potentially limit the clinical applicability of this technique.
机译：跨基底动脉瘤的经前斜肌途径并不广泛。这项研究的目的是对11具尸体头上的先进鼻内技术对基底动脉瘤采用经跨峰方法进行可行性评估。锁骨硬膜从蝶鞍暴露于颈内动脉（ICA）的旁斜节之间的大孔。倒置的硬脑膜“ U”瓣皮下暴露基底动脉。记录手术测量的最大尺寸。评估了多种器械的手术可操作性以及放置近端和远端血管夹的熟练程度。从前胸膜到基底动脉测得的平均手术深度（±标准偏差）为110±6 mm。外侧翼廊受内侧翼状（肉（平均宽度21±2 mm）和腹下肌ICA（平均宽度20±2 mm）限制。经颅cli骨切除术的平均尺寸为19±2 mm（宽度）和23±4 mm（高度）。分别有100％，91％和64％的患者可能会暴露基底小脑-前小脑下动脉连接处，小脑上动脉和基底帽。在所有情况下均实现了近端和远端动脉瘤夹的放置。根据我们的发现，经腹腔镜鼻内窥镜手术方法可提供基底动脉的出色可视化效果。夹子的应用和器械的可操作性被认为足以进行基底动脉瘤手术。控制重大出血的手术技能和仪器可能会限制该技术的临床适用性。

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