J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702535
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Assessment of Vascular Configurations of the Suprachiasmatic Region Using Endoscopic Endonasal Corridors: A Cadaveric Anatomical Study

Hongwei Zhu
1   Department of Neurological Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
2   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
,
Amandeep S. Ahluwalia
3   University of Chicago, Chicago, Illinois, United States
,
Ivan El-Sayed
2   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
4   Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, California, United States
,
Adib A. Abla
2   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
5   Department of Neurological Surgery, University of California, San Francisco, California, United States
,
Roberto Rodriguez Rubio
2   Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, United States
4   Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, California, United States
5   Department of Neurological Surgery, University of California, San Francisco, California, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

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Background: Endoscopic endonasal surgery has been an effective approach to treat suprasellar lesions, including tumor and vascular pathology. Understanding the anatomical variations of anterior cerebral communicating artery (ACoA) complex is relevant to guarantee a safe surgery and reducing complications through endoscopic endonasal surgery.

Methods: An endoscopic transplanum–transtubercular approach was performed on 36 cadaveric heads (72 sides). We studied and classified the anatomical variations of ACoA complex. The feasible of reaching ACoA and its adjacent structure relationship was assessed. We also qualified surgical exposure of lamina terminalis influenced by the variation of ACoA complex. Surgical exposure was measured using three coordinates obtained by a neuronavigation system. A Student’s t-test was used to compare the means of the various parametric variables, and a p-value of less than 0.05 was considered statistically significant.

Result: The ACoA complex was observed in all 36 specimens. The regular ACoA complex configuration was found in 15 (41.7%) of specimens: 8 cases (22.2%) with twisted ACoA and 7 cases (19.4%) without twisted ACoA. The ACoA complex anatomical variations encountered were the following: accessory A2 (5, 13.9%), common trunk of ACA with absence of ACoA (5, 13.9%), hypoplasia ACoA (3, 8.3%), asymmetry A1 (2, 5.6%), fenestrated ACoA (2, 5.6%), accessory ACoA (2, 5.6%), azygos ACA (1, 2.8%), and aneurysm (1, 2.8%). The mean length of ACoA was 2.63 ± 1.39 mm (0.5–6.5 mm) and the mean diameter of ACoA was 2.07 ± 0.83 mm (0.8–4.3 mm). The RAHs were found as a single vessel in 41 (56.9%), two vessels in 24 (33.3%), three in 4 (5.6%), and absent in 3 (4.2%) of the 72 hemispheres dissected. The 96 (95.0%) of the RAHs could be identified within 4 mm proximal or distal from ACoA in all 101 RAHs. After elevating the ACoA, the lamina terminalis exposure area achieved the 59.87 ±12.88 mm2, and promoted 80.1% comparing before elevating the ACoA (33.11 ± 17.75 mm2, p < 0.001).

Conclusion: A higher incidence of variations in the anterior communicating artery complex can be encountered in the endoscopic transplanum–transtubercular approach. The relationship between the ACoA complex and the optic chiasm has different meaning for reaching ACoA complex and exposure lamina terminalis through suprachiasmatic corridor in endoscopic transplanum–transtubercular approach.

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