Once considered far-fetched, endoscopic endonasal clipping (EEC) has been reported as a feasible alternative route for treating intracranial aneurysms located in the midline. Appropriately, debates regarding EEC applicability have arisen amongst the neurosurgical community. We aim to define the safety, effectiveness, and current state-of-art in the use of EEC for intracranial aneurysms. Two databases (PubMed, Cochrane) were queried for intracranial aneurysms that underwent EEC between inception and 2019. Literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data regarding clinical presentation, radiological imaging, and outcome were extracted and analyzed from selected publications. Nine studies with 27 patients (8 males, 19 females), harboring 35 aneurysms (9 ruptured, 26 nonruptured), met the predetermined inclusion criteria. Patient age range is from 34 to 70 (median = 50) years old. Four aneurysms were considered not suitable for EEC during the procedure, and two aneurysms required additional treatment, leading to an overall treatment success (obliteration) rate of 86%. Complications occurred in 7 patients (26%), including CSF leakage in 5 patients (18%) and ischemic complications in 4 (15%). Among the cases reported, complications occurred more frequently in posterior circulation aneurysms in comparison with anterior circulation aneurysms (62.5 vs 10.5%). Ischemic complications occurred in 4 out of 8 posterior circulation aneurysms. Although feasible, EEC is associated with a significant risk of complications, with rates identified that are significantly higher than established open clipping or endovascular management. The current data suggest that transcranial clipping and endovascular occlusion are still the primary indication for treating intracranial aneurysms.

中文翻译：

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内镜鼻腔内颅内动脉瘤夹闭术的安全性和有效性：系统评价。

一旦被认为牵强，内镜下鼻内夹（EEC）被报道为治疗位于中线的颅内动脉瘤的可行替代途径。适当地，在神经外科界中已经出现了关于EEC适用性的争论。我们的目标是定义在颅内动脉瘤中使用EEC的安全性，有效性和最新技术。对于两个数据库（PubMed，Cochrane）进行了查询，以了解在开始至2019年期间发生过EEC的颅内动脉瘤。根据PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了文献综述。从选定的出版物中提取和分析有关临床表现，放射影像学和结果的数据。九项研究共27例患者（男性8例，女性19例），包含35个动脉瘤（9个破裂，26个未破裂），符合预定的纳入标准。患者年龄范围是34至70岁（中位数= 50）。在此过程中，有4个动脉瘤被认为不适合EEC，而2个动脉瘤需要额外的治疗，导致总体治疗成功（闭塞）率为86％。并发症发生于7例（26％），包括脑脊液漏5例（18％）和缺血性并发症4例（15％）。在报告的病例中，与后循环动脉瘤相比，后循环动脉瘤的并发症发生率更高（62.5比10.5％）。8个后循环动脉瘤中有4个发生缺血性并发症。尽管可行，但EEC会带来很大的并发症风险，确定的比率明显高于既定的开放性夹闭或血管内管理​​。目前的数据表明，经颅夹闭和血管内闭塞仍是治疗颅内动脉瘤的主要指征。