title: Extended endoscopic endonasal transclival clipping of posterior circulation aneurysms--an alternative to the transcranial approach.
abstract: BACKGROUND
  Transcranial clipping of most posterior circulation aneurysms is one of the most difficult procedures, with high morbidity, and endovascular coiling is an alternative with less risk, but is not devoid of complications and not suitable for all aneurysms. Here we describe four cases of posterior circulation aneurysms clipped via the extended endoscopic endonasal transclival route. To the best of our knowledge, this is the first report of basilar top and posterior cerebral artery aneurysms being clipped endonasally.
  
  
  RESULTS
  Four patients with posterior circulation aneurysms underwent extended endoscopic endonasal transclival clipping of the aneurysm. The age range was 35-70 years. There were two males and two females. Three of the four patients presented after the rupture of aneurysms, and the other patient presented with sudden-onset left hemiparesis probably due to thromboembolism from a large unruptured left posterior cerebral artery (PCA) aneurysm. On evaluation with four-vessel digital subtraction angiography (DSA), two patients had a basilar apex aneurysm, one had a basilar trunk aneurysm, and the other had a PCA (P1) aneurysm. Postoperatively, two patients had good recovery. One patient with a PCA aneurysm and another with a basilar apex aneurysm had fresh postoperative deficits. One patient developed postoperative CSF rhinorrhea.
  
  
  CONCLUSIONS
  Endoscopic extended transnasal surgery is an expanding field in neurosurgery with a steep learning curve. With improvement in techniques and instrumentation the use of this approach for clipping posterior circulation aneurysms can become an effective alternative in the treatment of aneurysms.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India. sampath.somanna@gmail.com.
authors.forename: Sampath
authors.initials: S
authors.lastname: Somanna
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
authors.forename: R Arun
authors.initials: RA
authors.lastname: Babu
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
authors.forename: Dwarakanath
authors.initials: D
authors.lastname: Srinivas
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
authors.forename: Kannepalli V L
authors.initials: KV
authors.lastname: Narasinga Rao
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, 560029, Karnataka, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Vazhayil
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009666:Nose / Q000601:surgery
keywords: Aneurysm; Basilar artery; Clipping; Endonasal; Endoscopic; Transclival