caa a22 4500 60621464X CHVBK 20210128101054.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s00701-015-2610-6 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2610-6 Extended endoscopic endonasal transclival clipping of posterior circulation aneurysms—an alternative to the transcranial approach [Elektronische Daten] [Sampath Somanna, R. Babu, Dwarakanath Srinivas, Kannepalli Narasinga Rao, Vikas Vazhayil] Background: Transcranial clipping of most posterior circulation aneurysms is 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 not suitable for all aneurysms. Here we describe four cases of posterior circulation aneurysms clipped via the extended endoscopic endonasal transclival route. To the best of our knowledge, this is the first report of basilar top and posterior cerebral artery aneurysms being clipped endonasally. Methods and results: Four patients with posterior circulation aneurysms underwent extended endoscopic endonasal transclival clipping of the aneurysm. The age range was 35-70years. There were two males and two females. Three of the four patients 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 four-vessel digital subtraction angiography (DSA), two patients had a basilar apex aneurysm, one had a basilar trunk aneurysm, and the other had a PCA (P1) aneurysm. Postoperatively, two patients had good recovery. One patient with a PCA aneurysm and another with a basilar apex aneurysm had fresh postoperative deficits. One patient developed postoperative CSF rhinorrhea. Conclusion: 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. Springer-Verlag Wien, 2015 Aneurysm nationallicence Basilar artery nationallicence Clipping nationallicence Endonasal nationallicence Endoscopic nationallicence Transclival nationallicence Somanna Sampath Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut Babu R. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut Srinivas Dwarakanath Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut Narasinga Rao Kannepalli Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut Vazhayil Vikas Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2077-2085 0001-6268 157:12<2077 2015 157 701 https://doi.org/10.1007/s00701-015-2610-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 brief-communication jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2610-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Somanna Sampath Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut NATIONALLICENCE 700 1- Babu R. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut NATIONALLICENCE 700 1- Srinivas Dwarakanath Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut NATIONALLICENCE 700 1- Narasinga Rao Kannepalli Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut NATIONALLICENCE 700 1- Vazhayil Vikas Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bangalore, Karnataka, India aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2077-2085 0001-6268 157:12<2077 2015 157 701