Pittsburgh, February 1, 2006 -- The Minimally Invasive endoNeurosurgery Center (MINC) at the University of Pittsburgh Medical Center continues to advance the field of endoscopic transnasal surgery. The new endoscopic operating room at UPMC Presbyterian has been operational for several months and has spawned several exciting new breakthroughs. In November of 2005, a transnasal-endoscopically-treated aneurysm procedure was performed—a first according to Arlan Mintz, MD, assistant professor of neurological surgery.

A 51-year-old woman presented with progressive clumsiness and weakness as well as sensory alteration. A cerebral angiogram revealed a large right vertebral artery aneurysm (fig 1) that could be seen on the axial MRI compressing the medulla (fig 2). Michael Horowitz, MD, associate professor of neurological surgery, was able to trap this aneurysm endovascularly with GDC coils placed in the vertebral artery above and below the fusiform aneurysm. However, there were concerns about continued mass effect on the brainstem. To relieve this mass effect, a decompressive procedure was required. Direct surgical approaches to this region are surgically challenging skull base approaches.

Recent advances in endoscopic transnasal surgery at UPMC allowed Amin Kassam, MD, associate professor of neurological surgery, and Carl Snyderman, MD, associate professor of otolaryngology and neurological surgery—MINC co-directors—to approach the aneurysm transnasally via a transclival intradural route (fig 3 and 4). Aneurysm clips were placed above and below the aneurysm to ensure there was no further filling (fig 5) and an aneurysmorraphy was completed to resect the thrombus and relieve the mass effect. Post-operative improvement in motor function, incoordination and sensory symptoms were noted. Post-operative CT scans and cervical flexion-extension views confirmed craniocervical stability.

The role of endoneurosurgery for the treatment of cerebrovascular diseases will likely augment currently available therapies and prove most valuable for lesions in the posterior fossa along the clivus that prove difficult for access via conventional techniques.