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Anatomic feasibility of endoscopic endonasal intracranial aneurysm clipping: a systematic review of anatomical studies

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Abstract

Clinical studies have suggested the endoscopic endonasal approach (EEA) for aneurysm clipping as a feasible way to treat select intracranial aneurysms. Among neurosurgery, there is not a consensus on the utility of EEA aneurysm clipping. This review aims to define the anatomic feasibility of EEA for aneurysm clipping. Two databases (PubMed, Cochrane) were searched for anatomical studies assessing EEA for intracranial aneurysm clipping. Literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quantitative anatomical studies were included. Eleven studies met inclusion criteria. Vascular exposure and clip placement on vessels of interest were possible, although only one study assessed these parameters with physical aneurysm models. Anterior circulation vessels, although accessible in over 90% of specimens, had low successful clipping rates in a small and large aneurysm models. Small and large model posterior circulation aneurysms were more readily clipped. Proximal and distal controls were readily attainable in posterior circulation aneurysms, but not anterior. This current literature review highlights the relevance of anatomical studies in assessing the feasibility of the EEA for clipping intracranial aneurysms. As such, anterior circulation aneurysms are poor candidates for EEA given difficulties in clip placement and obtaining proximal control and distal control in small and large aneurysms. While our results suggest that clipping of posterior circulation aneurysms is feasible from a technical stand of view, further clinical experience is required to assess its feasibility in terms of safety and efficacy, balancing the indications with endovascular treatment options.

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Not applicable as this is a review and all methods and data are in the published papers that have been cited.

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Authors and Affiliations

  1. College of Medicine, The Ohio State University, 370 W. 9th Ave, Columbus, OH, 43210, USA

    Varun S. Shah

  2. Department of Neurosurgery, University of Colorado, Aurora, CO, USA

    Rafael Martinez-Perez

  3. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Ave., N-1049 Doan Hall, Columbus, OH, 43210, USA

    Daniel Kreatsoulas, Douglas A. Hardesty & Daniel M. Prevedello

  4. Department of, Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ricardo Carrau, Douglas A. Hardesty & Daniel M. Prevedello

Authors
  1. Varun S. Shah
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  2. Rafael Martinez-Perez
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  3. Daniel Kreatsoulas
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  4. Ricardo Carrau
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  5. Douglas A. Hardesty
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  6. Daniel M. Prevedello
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Correspondence to Varun S. Shah or Daniel M. Prevedello.

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Conflict of interest

Daniel M. Prevedello is a consultant for Integra LifeSciences Corp, Stryker Corporation and Medtronic Corp. Daniel Prevedello has equity on 3 rivers LLC, eLUM Technologies, LLC and Soliton LLC. Daniel Prevedello receives royalties from KLS-Martin, ACE Medical, and Mizuho.

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Informed consent and ethical approval were not deemed necessary by the local ethics in view of the design of the study (review).

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Shah, V.S., Martinez-Perez, R., Kreatsoulas, D. et al. Anatomic feasibility of endoscopic endonasal intracranial aneurysm clipping: a systematic review of anatomical studies. Neurosurg Rev 44, 2381–2389 (2021). https://doi.org/10.1007/s10143-020-01434-9

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  • DOI: https://doi.org/10.1007/s10143-020-01434-9

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