title: The extended endoscopic endonasal transplanum transtuberculum approach to the anterior communicating artery complex: anatomic study.
abstract: BACKGROUND
  When performing a transplanum transtuberculum approach, dealing with the anterior communicating artery (ACoA) complex is inevitable. The aim of this study is to provide quantitative anatomical information regarding the ACoA complex and its bony and neural relationships, when exposed through this approach.
  
  
  METHODS
  The endoscopic endonasal transplanum transtuberculum approach was performed on ten human cadaver heads. In each specimen, radiological studies were performed. A three-dimensional model of the approach was reconstructed. Measured parameters were: exposure of the vessels; distance between the proximal anterior cerebral artery (A1) and the optic chiasm; dimension of the bone opening. The feasibility to perform clip placement was graded as "possible" or "not possible".
  
  
  RESULTS
  Dimension of bone opening varied from 88 to 53 mm(2). The ACoA was exposed for 3 mm ± 2 mm, A1 for 17 mm ± 9 mm, the distal anterior cerebral artery (A2) for 12 mm ± 3 mm, the recurrent artery of Heubner (RAH) for 16 mm ± 4 mm. Clip placement was possible on the ACoA, A2, and distal segment of A1 in all cases, and on the proximal segment of A1 in one instance. The distance between A1 and the optic chiasm measured 9 mm ± 2 mm.
  
  
  CONCLUSIONS
  The ACoA, A2, and the distal segment of A1 can be visualized and controlled through the transplanum transtuberculum approach. The relationship between A1, gyrus rectus, and optic chiasm is the main determinant for the exposure and control of the vessel. The olfactory nerve can represent a surgical landmark for the identification of the A1 origin. The whole course of the RAH can be visualized trough this approach.
authors.affiliation: Laboratory of Surgical NeuroAnatomy (LSNA), Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, C/ Casanova 143, 08036, Barcelona, Spain, elenadavella@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: d'Avella
authors.forename: Matteo
authors.initials: M
authors.lastname: De Notaris
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.forename: Joan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Cristian
authors.initials: C
authors.lastname: Gragnaniello
authors.forename: Marija
authors.initials: M
authors.lastname: Mavar
authors.forename: Enrique
authors.initials: E
authors.lastname: Ferrer
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
mesh_terms: D020771:Anterior Cerebral Artery / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*