Table of Contents Author Guidelines Submit a Manuscript
BioMed Research International
Volume 2014, Article ID 703792, 9 pages
http://dx.doi.org/10.1155/2014/703792
Research Article

Extended Endoscopic Endonasal Approaches for Cerebral Aneurysms: Anatomical, Virtual Reality and Morphometric Study

1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
2Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
3Division of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
4Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB), Information & Communication Technologies Department, Universitat Pompeu Fabra (UPF), Tànger 122-140, 08018 Barcelona, Spain
5Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
6Medical Sciences Department, Faculty of Medicine, University of Girona, Emili Grahit 77, 17071 Girona, Spain
7Department of Radiology, Neuroradiology Division, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain

Received 30 April 2013; Accepted 24 October 2013; Published 19 January 2014

Academic Editor: Heather F. Smith

Copyright © 2014 Alberto Di Somma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. The purpose of the present contribution is to perform a detailed anatomic and virtual reality three-dimensional stereoscopic study in order to test the effectiveness of the extended endoscopic endonasal approaches for selected anterior and posterior circulation aneurysms. Methods. The study was divided in two main steps: (1) simulation step, using a dedicated Virtual Reality System (Dextroscope, Volume Interactions); (2) dissection step, in which the feasibility to reach specific vascular territory via the nose was verified in the anatomical laboratory. Results. Good visualization and proximal and distal vascular control of the main midline anterior and posterior circulation territory were achieved during the simulation step as well as in the dissection step (anterior communicating complex, internal carotid, ophthalmic, superior hypophyseal, posterior cerebral and posterior communicating, basilar, superior cerebellar, anterior inferior cerebellar, vertebral, and posterior inferior cerebellar arteries). Conclusion. The present contribution is intended as strictly anatomic study in which we highlighted some specific anterior and posterior circulation aneurysms that can be reached via the nose. For clinical applications of these approaches, some relevant complications, mainly related to the endonasal route, such as proximal and distal vascular control, major arterial bleeding, postoperative cerebrospinal fluid leak, and olfactory disturbances must be considered.