Anatomical and technical aspects of the contralateral approach for multiple aneurysms

Oliveira, Evandro de; Tedeschi, Hélder; Siqueira, Mário G.; Ono, Michio; Fretes, C.; Rhoton, Albert L.; Peace, David A.

doi:10.1007/bf01411716

Cited by 50 publications

(35 citation statements)

References 26 publications

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“…Considering patients with multiple and bilateral aneurysms, which account for 32% of all patients treated in our department annually 10 , a single craniotomy has the advantage of avoiding a second approach and anaesthesia, and reducing the risks of rebleeding 11 , especially when an acute surgery is not possible. This technique, however, is not recommended for all the patients.…”

Section: Discussionmentioning

confidence: 99%

Progression of an arterial infundibulum to aneurysm: case report

Martins

Macanovic

Silva

et al. 2002

Arq. Neuro-Psiquiatr.

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-In this case an aneurysm of the right posterior communicating artery developed 11 months after an infundibular dilation of this artery had been angiographycally and surgically demonstrated. In the best of the authors' knowledge, there are only eleven such cases reported in the literature. This report brings about diagnostic and therapeutic questions regarding arterial infundibula and the need of a better understanding of those lesions.KEY WORDS: aneurysm, arterial infundibulum, bilateral supratentorial aneurysms, infundibular dilation.Progressão de infundíbulo arterial a aneurisma: relato de caso Progressão de infundíbulo arterial a aneurisma: relato de caso Progressão de infundíbulo arterial a aneurisma: relato de caso Progressão de infundíbulo arterial a aneurisma: relato de caso Progressão de infundíbulo arterial a aneurisma: relato de caso RESUMO -Relatamos a transformação de uma dilatação infundibular da origem da artéria comunicante posterior em aneurisma, após onze meses do diagnóstico angiográfico e cirúrgico. Apenas onze casos semelhantes foram descritos na literatura internacional. Relatos como esse trazem à tona os problemas diagnósticos e terapêuticos representados por essas lesões e suscitam a necessidade do melhor entendimento das dilatações infundibulares encontradas nas artérias cerebrais. PALAVRAS-CHAVE: aneurismas, aneurismas bilaterais, dilatação infundibular, infundíbulo.

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Section: Discussionmentioning

confidence: 99%

Progression of an arterial infundibulum to aneurysm: case report

Martins

Macanovic

Silva

et al. 2002

Arq. Neuro-Psiquiatr.

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“…The successful management of supratentorial aneurysms by keyhole supraorbital craniotomy has recently been reported 9,10,13,17,21,24,[26][27][28][29][30][31][32] . However, a remarkable controversy remains regarding the choice between the supraorbital keyhole approach 9,32) , and the pterional approach 12,16) , which is the traditional method for the surgical management of patients with anterior circulation aneurysms. Here, we describe our preliminary experience with the supraor-bital keyhole approach for the clipping of anterior circulation aneurysms and compare it with the traditional pterional approach in terms of patient's subjective outcome assessment.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Park

Han

2009

J Korean Neurosurg Soc

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Objective : Conventional pterional approach is a commonly used neurosurgical technique for the treatment of cerebral aneurysms. However, this technique requires more extensive brain exposure than other key hole approaches and is sometimes associated with surgical traumatization or cosmetic problems. The aim of this study was to compare the postoperative outcome between pterional and supraorbital keyhole approaches in the patients with anterior circulation aneurysms. Methods :The authors reviewed patients with anterior circulation aneurysms who underwent aneurysm clipping via pterional or supraorbital keyhole approach at a single institute over a period of 2 years. Ninety-eight patients harboring 108 aneurysms were included in this study. Various outcomes were recorded, which included clinical grade, cosmetic problems, patients' satisfaction and complications such as chewing discomfort, frontal muscle weakness, hyposmia, infection. Results :The supraorbital approach exhibited a shorter operation time compared with the pterional approach. Complications such as chewing discomfort occurred less frequently in the supraorbital approach group. Moreover, the cosmetic outcome was significantly better in the supraorbital group than in the pterional group. Conclusion : The supraorbital keyhole approach reduced intra-and postoperative complications, including chewing discomfort and cosmetic disturbances, compared with the conventional pterional approach.

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“…Microsurgical clipping of these aneurysms remains challenging due to their anatomical complexity, the need for anterior clinoidectomy, poorly accessible proximal control, the need for complex clip configurations like rightangle fenestrated clipping, and proximity to vital structures, including optic nerve, carotid artery, and cavernous sinus. Surgical results with ophthalmic segment aneurysms have improved with advances in microsurgical technique and anatomical research (2,4,6,8,13,14), but so too have endovascular results, especially with the introduction of stentassisted coiling and flow diverters. Early experiences with the pipeline embolization device and other similar devices have been favorable in the ophthalmic segment, limiting surgical indications to aneurysms with wide necks, large or giant size, intraluminal thrombus, optic nerve compression, recurrence after prior endovascular therapy, and contraindication to antiplatelet therapy.…”

Section: Introductionmentioning

confidence: 99%

Bilateral ophthalmic segment aneurysm clipping with one craniotomy:operative technique and results

Nacar¹,

Rodríguez-Hernández²,

Ulu³

et al. 2014

Turkish Neurosurgery

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AIm: Surgical indications for ophthalmic segment aneurysms are getting narrower due in part to success of endovascular techniques like flow diverters. Wide necks, large size, intraluminal thrombus, optic nerve compression or recurrence after endovascular therapy make the case for surgical treatment. Bilateral aneurysms are less established but worth considering surgical indication. Our objective is to review a series of bilateral ophthalmic segment aneurysms managed through a single craniotomy, describe the surgical technique and evaluate the results. mATERIAl and mEThods: Between 1997 and 2012, 11 patients with bilateral ophthalmic segment aneurysms were treated through a single craniotomy at UCSF Medical Center. An intradural clinoidectomy was performed to expose and clip the ipsilateral aneurysm. Medially and superiorly projecting contralateral aneurysm could be clipped through the interoptic triangle without clinoidectomy. Indocyanin green videoangiography was performed routinely.REsulTs: Eleven patients harboring 22 ophthalmic segment aneurysms were treated with a single craniotomy. Complete neck occlusion was achieved in 96 % of aneurysms. One patient presenting with subarachnoid hemorrhage Hunt-Hess grade 5 died from vasospasm complications. The remaining 10 patients had good outcomes (mRS ≤ 2) after a mean 2.2 years follow up. There were no recurrences after surgical treatment. CoNClusIoN:Decompressing the optic nerve, completely occluding the aneurysm neck, providing a durable repair and avoiding antiplatelet agents are the well established advantages of microsurgical management. This experience demonstrates safety and feasibility of contralateral clipping of carefully selected ophthalmic segment aneurysms, thus pointing another advantage of surgical clipping when bilateral aneurysms are diagnosed. KEywoRds: Bilateral aneurysm, Ophthalmic segment, Surgical clipping, Treatment ÖZAmAÇ: Oftalmik kısım anevrizmalarında cerrahi tedavi endikasyonları akım yönlendiriciler gibi endovasküler tekniklerin gelişmesiyle giderek daralmaktadır. Geniş boyunlu, büyük boyutlu, lumen içi thrombuslu, optik sinir basılı veya endovasküler cerrahi sonrası nüks olan olgularda cerrahi ön plana çıkmaktadır. Bilateral anevrizma varlığı ise daha az değerlendirilen ama cerrahi düşünülmesine değer bir durumdur. Amacımız, tek bir kraniotomi ile tedavi edilen bilateral oftalmik kısım anevrizmalı hasta serisini incelemek, cerrahi tekniği tanımlamak ve sonuçları değerlendirmektir. yÖNTEm ve GEREÇlER: 1997-2012 yılları arasında UCSF Tıp Merkezi'nde 11 bilateral oftalmik kısım anevrizmalı hasta tek kraniotomi ile tedavi edilmiştir. İpsilateral anevrizmayı ortaya koymak ve kliplemek için intradural klinoidektomi yapılmıştır.Mediale ve superior uzanan kontrlateral anevrizmalar klinoidektomi yapılmaksızın interoptik üçgenden kliplenmiştir. Indocyanin yeşili videoanjiyografi rutin olarak kullanılmıştır.BulGulAR: 22 oftalmik kısım anevrizması olan 11 hasta tek kraniotomi ile tedavi edildi. Hastaların % 96'sında anevrizma boynu tam kapa...

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Anatomical and technical aspects of the contralateral approach for multiple aneurysms

Cited by 50 publications

References 26 publications

Progression of an arterial infundibulum to aneurysm: case report

Progression of an arterial infundibulum to aneurysm: case report

Microsurgical Experience with Supraorbital Keyhole Operations on Anterior Circulation Aneurysms

Bilateral ophthalmic segment aneurysm clipping with one craniotomy:operative technique and results

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