title: Anterior communicating artery aneurysm clipped via an endoscopic endonasal approach: technical note.
abstract: BACKGROUND
  The anterior communicating artery (AcoA) aneurysm is one of the most challenging aneurysms. As endovascular techniques evolve, a remaining challenge is the reduction of complications related to the surgical approach. Although the endonasal approach is widely used for pituitary adenomas and is increasingly popular for suprasellar tumors, only 2 aneurysm cases have been reported.
  
  
  OBJECTIVE
  To the best of our knowledge, we are reporting the first case of successful endoscopic endonasal clipping of an unruptured ACoA aneurysm.
  
  
  METHODS
  An ACoA aneurysm was discovered in a 55-year-old man before he was to undergo an endoscopic biopsy of an orbital lesion. Because of the operative corridor formed during this first operation and ideal conformation of the aneurysm for this line of sight, we formulated an endoscopic route for this ACoA aneurysm.
  
  
  RESULTS
  An endoscopic endonasal transplanum-transtuberculum approach was performed. Proximal and distal control was obtained, and the AcoA aneurysm was successfully clipped. The postoperative course was uneventful with a rapid recovery.
  
  
  CONCLUSIONS
  The endoscopic approach provided another option the value of which value must be weighed in terms not only of feasibility but the patient's best interest. We caution extreme prudence if considering this procedure as an alternative to well-established techniques. Yet its upward route offers limited retraction for deep-seated lesions. Rapid progress of endoscopic techniques may prove promising for well-selected cases of ACoA aneurysms.
authors.affiliation: Department of Neurosurgery, Strasbourg University Hospital, CHU de Hautepierre, 1 avenue Moliere, Strasbourg, France. sebastien.froelich@chru-strasbourg.fr
authors.forename: Sebastien
authors.initials: S
authors.lastname: Froelich
authors.forename: Helene
authors.initials: H
authors.lastname: Cebula
authors.forename: Christian
authors.initials: C
authors.lastname: Debry
authors.forename: Patrick
authors.initials: P
authors.lastname: Boyer
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D002533:Cerebral Angiography; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*