title: The Expanded Endoscopic Endonasal Approach to Anterior Communicating Artery Aneurysms: A Cadaveric Morphometric Study.
abstract: OBJECTIVE
  The purpose of this study was to explore the endoscopic endonasal approach to the anterior communicating artery complex.
  
  
  METHODS
  Anatomic, morphometric analysis of human cadaver heads.
  
  
  METHODS
  Fifteen latex-injected adult cadaver heads.
  
  
  METHODS
  The anatomic boundaries of the operative field and the dimensions of exposure of the anterior communicating artery (ACoA) complex were measured and clip placement feasibility was assessed.
  
  
  RESULTS
  Exposure of the ACoA and bilateral A1 and A2 segments was accomplished in all 15 cadaver heads. Average length of the exposed ACoA was 3 ± 1 mm, the left A1 was 5 ± 3 mm and right A1 was 5 ± 1 mm, while the A2 segment was 5 ± 2 mm bilaterally. The average distance from the alar floor to the ACoA was 95 mm, while proximal lateral limit measured between the alar floor margins was 36 mm. The distal lateral limit as defined by the distance between the lateral most exposed margins of the chiasm was 19 mm. Clip placement was accomplished for the ACoA and the A1 and A2 segments bilaterally in all specimens.
  
  
  CONCLUSIONS
  The endoscopic, endonasal transtuberculum, transplanum approach is an anatomically feasible alternative to treating select aneurysms of the ACoA complex.
authors.affiliation: Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ajay S
authors.initials: AS
authors.lastname: Unnithan
authors.affiliation: Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Oluwaseun
authors.initials: O
authors.lastname: Omofoye
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Lemos-Rodriguez
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Satyan B
authors.initials: SB
authors.lastname: Sreenath
authors.affiliation: Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Doan
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
authors.affiliation: Cleveland Clinic, Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA.
authors.forename: Pablo
authors.initials: P
authors.lastname: Recinos
authors.affiliation: Department of Neurosurgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA. Electronic address: deanna_sasaki-adams@med.unc.edu.
authors.forename: Deanna M
authors.initials: DM
authors.lastname: Sasaki-Adams
mesh_terms: D002536:Cerebral Arteries / Q000033:anatomy & histology* / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D009666:Nose; D013525:Surgical Instruments
keywords: Anterior cerebral artery aneurysm; Anterior communicating artery aneurysm; Clipping aneurysms; Endoscopic endonasal approach; Transtuberculum approach