title: Extended endoscopic endonasal approaches for cerebral aneurysms: anatomical, virtual reality and morphometric study.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy ; Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Alberto
authors.identifier: 0000-0002-3253-3448
authors.initials: A
authors.lastname: Di Somma
authors.affiliation: Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain ; Division of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy ; Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Vita
authors.identifier: 0000-0001-6404-3526
authors.initials: V
authors.lastname: Stagno
authors.affiliation: Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB), Information & Communication Technologies Department, Universitat Pompeu Fabra (UPF), Tànger 122-140, 08018 Barcelona, Spain.
authors.forename: Luis
authors.identifier: 0000-0002-7379-5348
authors.initials: L
authors.lastname: Serra
authors.affiliation: Division of Neurosurgery, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.affiliation: Department of Otorhinolaryngology, Rhinology Unit, Hospital Clinic de Barcelona, Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.affiliation: Medical Sciences Department, Faculty of Medicine, University of Girona, Emili Grahit 77, 17071 Girona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: San Molina
authors.affiliation: Department of Radiology, Neuroradiology Division, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.affiliation: Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain.
authors.forename: Alberto
authors.identifier: 0000-0002-2710-6433
authors.initials: A
authors.lastname: Prats-Galino
mesh_terms: D004724:Endoscopy / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery