{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:56:02Z","timestamp":1785372962182,"version":"3.55.0"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The authors examined the clipping of middle cerebral artery (MCA) aneurysms using the endoscopic transorbital approach (ETOA) with cadavers and in clinical cases to clarify which patients are good candidates based on preoperative imaging data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>To determine the indications for MCA clipping using an ETOA with superior-lateral orbital rim osteotomy, 10 sides of 5 cadavers were investigated. The clippable range, defined as the horizontal range, and exposure of the middle cranial fossa base, defined as the vertical extent area, were evaluated. To assess the ETOA trajectory in the MCA, the superior and inferior maximal angles based on the nasion-sella line were evaluated during cadaveric dissection. To test the surgical properties for actual use, 2 clinical cases were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The bases of the middle cerebral fossa, which were located below the sphenoid ridge, were accessible in all 5 cadavers. The suction tip and clip applier did not conflict with each other when access was made approximately 17.6 \u00b1 3 mm (mean \u00b1 SD) laterally from the cranial midline and 6 \u00b1 2 mm from the median temporal bone margin (clippable range). The superior angle was 16.7\u00b0 \u00b1 7.8\u00b0, and the inferior angle was 18.7\u00b0 \u00b1 9.6\u00b0. Two clinical cases underwent procedures using the ETOA. The aneurysms were at the MCA bifurcation in the anterior direction. The clippable ranges of the patients were 29 mm and 31 mm, respectively, and the distances from the midline to the median temporal bone margins were 32 mm and 36 mm. The M1 lengths were 14.5 mm and 17.2 mm, and the maximal diameters of the aneurysms were 3.58 and 3.67 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Clipping using an ETOA is appropriate for MCA aneurysms with anterior, superior, and inferior dome projections. Aneurysms with a horizontal boundary from the anterior clinoid process to the lateral bone margin of the orbital ball and a vertical boundary around and below the sphenoid ridge can be properly clipped using the ETOA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.focus24870","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T13:24:54Z","timestamp":1764595494000},"page":"E9","source":"Crossref","is-referenced-by-count":2,"title":["Endoscopic transorbital approach for clipping middle cerebral artery aneurysms: a cadaveric study with clinical application (SevEN-14)"],"prefix":"10.3171","volume":"59","author":[{"given":"Sun","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiwoong","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Jin","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Hyung","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eui Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keun Young","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SeungWoo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ki","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do; and"},{"name":"Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations","volume":"19","author":"Cavallo LM","year":"2005","unstructured":"Cavallo LM, Messina A, Cappabianca P,  Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus. 2005;19(1):E2."},{"issue":"3","key":"b2","series-title":"Technical note. J Neurosurg","first-page":"852","article-title":"The transorbital keyhole approach: early and long-term outcome analysis of approach-related morbidity and cosmetic results","volume":"114","author":"Beseoglu K","year":"2011","unstructured":"Beseoglu K, Lodes S, Stummer W, Steiger HJ, Hanggi D. The transorbital keyhole approach: early and long-term outcome analysis of approach-related morbidity and cosmetic results. Technical note. J Neurosurg. 2011;114(3):852\u2013856."},{"issue":"4","key":"b3","series-title":"Neurosurgery","first-page":"537","article-title":"The supraorbital approach: technical note","volume":"11","author":"Jane JA","year":"1982","unstructured":"Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. 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J Neurosurg. 2018;129(5):1203\u20131216."},{"issue":"1","key":"b6","series-title":"Neurosurgery","first-page":"125","article-title":"Trans-supraorbital approach to supratentorial aneurysms","volume":"51","author":"Ramos-Z\u00fa\u00f1iga R","year":"2002","unstructured":"Ramos-Z\u00fa\u00f1iga R, Vel\u00e1zquez H, Barajas MA, L\u00f3pez R, S\u00e1nchez E, Trejo S. Trans-supraorbital approach to supratentorial aneurysms. Neurosurgery. 2002;51(1):125\u2013131."},{"issue":"5","key":"b7","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"376","article-title":"Endoscope-assisted transorbital keyhole surgical approach to ruptured supratentorial aneurysms","volume":"76","author":"Ho CL","year":"2015","unstructured":"Ho CL, Hwang PY. Endoscope-assisted transorbital keyhole surgical approach to ruptured supratentorial aneurysms. J Neurol Surg A Cent Eur Neurosurg. 2015;76(5):376\u2013383."},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"72","article-title":"Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms","volume":"134","author":"Ulutas M","year":"2021","unstructured":"Ulutas M, \u00c7inar K, Dogan I, Secer M, Isik S, Aksoy K. Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms. J Neurosurg. 2021;134(1):72\u201383."},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"347","article-title":"Transorbital keyhole approach to anterior communicating artery aneurysms","volume":"48","author":"Steiger HJ","year":"2001","unstructured":"Steiger HJ, Schmid-Elsaesser R, Stummer W, Uhl E. Transorbital keyhole approach to anterior communicating artery aneurysms. 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The transpalpebral versus the transciliary variant of the supraorbital keyhole approach: anatomic concepts for aneurysm surgery. Oper Neurosurg. 2020;19(1):E24\u2013E31."},{"issue":"2","key":"b14","series-title":"J Neurosurg","first-page":"463","article-title":"Endoscopic endonasal clip ligation of cerebral aneurysms: an anatomical feasibility study and future directions","volume":"124","author":"Szentirmai O","year":"2016","unstructured":"Szentirmai O, Hong Y, Mascarenhas L,  Endoscopic endonasal clip ligation of cerebral aneurysms: an anatomical feasibility study and future directions. J Neurosurg. 2016;124(2):463\u2013468."},{"issue":"1 Suppl Operative","key":"b15","series-title":"Neurosurgery","first-page":"234","article-title":"Endoscopic endonasal approach for clipping of ruptured and unruptured paraclinoid cerebral aneurysms: case report","volume":"68","author":"Germanwala AV","year":"2011","unstructured":"Germanwala AV, Zanation AM. 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Neurosurgery. 2002;51(1):125\u2013131."},{"issue":"5","key":"b7","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"376","article-title":"Endoscope-assisted transorbital keyhole surgical approach to ruptured supratentorial aneurysms","volume":"76","author":"Ho CL","year":"2015","unstructured":"Ho CL, Hwang PY. Endoscope-assisted transorbital keyhole surgical approach to ruptured supratentorial aneurysms. J Neurol Surg A Cent Eur Neurosurg. 2015;76(5):376\u2013383."},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"72","article-title":"Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms","volume":"134","author":"Ulutas M","year":"2021","unstructured":"Ulutas M, \u00c7inar K, Dogan I, Secer M, Isik S, Aksoy K. Lateral transorbital approach: an alternative microsurgical route for supratentorial cerebral aneurysms. 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J Korean Neurosurg Soc. 2020;63(1):4\u201313."},{"key":"b11","series-title":"World Neurosurg","first-page":"e349","article-title":"Selection strategy for optimal keyhole approaches for middle cerebral artery aneurysms: lateral supraorbital versus minipterional craniotomy","volume":"122","author":"Esposito G","year":"2019","unstructured":"Esposito G, Dias SF, Burkhardt JK,  Selection strategy for optimal keyhole approaches for middle cerebral artery aneurysms: lateral supraorbital versus minipterional craniotomy. World Neurosurg. 2019;122:e349\u2013e357."},{"issue":"2","key":"b12","series-title":"Asian J Neurosurg","first-page":"278","article-title":"The keyhole approach in anterior circulation aneurysm - current indication and limitation with review of literature","volume":"15","author":"Rathore L","year":"2020","unstructured":"Rathore L, Yamada Y, Kawase T, Kato Y, Senapati SB. 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Neurosurgery. 2011;68(1 Suppl Operative):234\u2013240."},{"issue":"1 Suppl 1","key":"b16","series-title":"Neurosurgery","first-page":"ONSE162","article-title":"The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report","volume":"59","author":"Kassam AB","year":"2006","unstructured":"Kassam AB, Mintz AH, Gardner PA, Horowitz MB, Carrau RL, Snyderman CH. The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report. Neurosurgery. 2006;59(1 Suppl 1):ONSE162\u2013ONSE165."},{"issue":"3","key":"b17","series-title":"Operative Surg","first-page":"309","article-title":"Transpalpebral approach \"eyelid incision\" for surgical treatment of intracerebral aneurysms: lessons learned during a 10-year experience","volume":"18","author":"Mao G","year":"2020","unstructured":"Mao G, Gigliotti M, Aziz K, Aziz K. 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