New Approach to Treating Ruptured Brain Aneurysms

Researchers at the University of North Carolina (UNC; Chapel Hill, USA) presented the first surgical case in which clip ligation of both a ruptured and unruptured paraclinoidal segment aneurysm was performed using only the EEA, in one setting. The procedure was performed on a 42-year-old woman who presented with aneurysmal subarachnoid hemorrhage. An arteriogram revealed an irregular 10-mm right paraclinoidal aneurysm projecting posteromedially, and a 5-mm wide-necked right ophthalmic artery aneurysm projecting superomedially.

The patient was taken to the operating room (OR), where clipping of both aneurysms were performed using an EEA with a pedicled nasoseptal flap reconstruction. The novel approach allowed for excellent visualization, without drilling of the clinoid process or mobilization of the optic nerve, and potential control of both the proximal and distal internal carotid artery. An intraoperative arteriogram showed obliteration of both aneurysms with patency of the surrounding vasculature. The patient did well postoperatively and was subsequently discharged home without any neurological deficits. The study was published ahead of print on December 30, 2010, in Neurosurgery.

"It's taking the best from the coiling procedure, because it's minimally invasive, and taking the best from the clipping procedure, because it's more permanent--and putting them together,” said study coauthor neurosurgeon Anand Germanwala, MD. "We're at the very beginning stage right now; I think people have opened their eyes to what this technique affords.”

The EEA is surgical technique involves a multidisciplinary team of neurosurgeons, ophthalmic surgeons, otolaryngologists, and spine surgeons, reaching tumors and lesions of the skull base and top of the spine directly by operating through the nose and sinuses. A specially designed endoscope provides light, and a lens for viewing and transmitting internal images. Highly crafted instruments are used alongside the endoscope for dissection and tumor removal.

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