Contralateral and Ipsilateral Microsurgical Approaches to Carotid-Ophthalmic Aneurysms

Fries, Georg; Perneczky, Axel; E, van Lindert; Bahadori-Mortasawi, F

doi:10.1097/00006123-199708000-00001

Cited by 74 publications

(47 citation statements)

References 24 publications

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“…The difficult proximal control and the narrow space to work with lead to a higher frequency of failed clipping procedures as well as to a higher surgical morbidity and mortality [2][3][4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Paraclinoid Aneurysms

Sun

2011

Interv Neuroradiol

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The anatomical complexity of the paraclinoid region has made surgical treatment of intracranial ophthalmic segment aneurysms (OSAs) difficult. This study evaluated the safety and efficacy of endovascular treatment of paraclinoid aneurysms. We conducted a retrospective study of 28 patients with 30 aneurysms of the paraclinoid in whom treatment with endovascular techniques was attempted. Patient age, sex, presence of subarachnoid hemorrhage, aneurysm type, size of aneurismal sac and treatment modality were reviewed. Clinical evaluation and control angiography were performed between one and 43 months. Overall, complete occlusion was obtained in 26 aneurysms (86.6%), nearly complete (>90%) occlusion in two aneurysms (6.7%) and incomplete occlusion was observed in two aneurysms (6.7%). All endovascular techniques were successful. Procedure-related complications were observed in two patients (7.1%). Patients underwent follow-up for a mean of 14.8 months (range 1–43 months). Repeated coil treatment was performed in one patient. One patient died of massive brain infarction six days postoperatively and thus no follow-up data were available for this case. In 27 patients with follow-up studies, aneurysm closure was complete in 22 (81.5%) and incomplete in five (18.5%). Endovascular treatment is a safe and efficient alternative approach for paraclinoid aneurysms.

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Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Paraclinoid Aneurysms

Sun

2011

Interv Neuroradiol

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“…3,5,11,12,21 The contralateral supraorbital keyhole approach has also been described by the pupils of Perneczky in detail. 10,22 Novak et al reported a case of a recurrent posterior fossa craniopharyngioma approached through the cistern magna from the contralateral side with an excellent outcome.…”

Section: Fig 4 Postoperative T2-weighted Axial (A-d) and Contrast-ementioning

confidence: 99%

Endoscopic fenestration of intraventricular cerebrospinal fluid cysts: the contralateral approach

Hugelshofer

Koechlin

Marcus

et al. 2016

JNS

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OBJECT The endoscopic fenestration of intraventricular CSF cysts has evolved into a well-accepted treatment modality. However, definition of the optimal trajectory for endoscopic fenestration may be difficult. Distorted ventricular anatomy and poor visibility within the cyst due to its contents can make endoscopic fenestration challenging if approached from the ipsilateral side. In addition, transcortical approaches can theoretically cause injury to eloquent cortex, particularly in patients with dominant-sided lesions. The aim of this study was to examine the value of the contralateral transcortical transventricular approach in patients with dominant-sided ventricular cysts. METHODS During a 5-year period between 2007 and 2011, 31 patients with intraventricular CSF cysts underwent surgery by the senior author (R.R.). Fourteen of these patients had cysts located on the dominant side. An image-guided endoscopic cyst fenestration via the contralateral transcortical transventricular approach was performed in 11 patients. A retrospective chart review was performed in all these patients to extract data on clinical presentation, operative technique, and surgical outcome. RESULTS The most common presenting symptom was headache, followed by memory deficits and cognitive deterioration. In all cases CSF cysts were space occupying, with associated obstructive hydrocephalus in 8 patients. Image-guided endoscopic fenestration was successfully performed in all cases, with septum pellucidotomy necessary in 6 cases, and endoscopic third ventriculostomy in 1 case for additional aqueductal occlusion. Postoperative clinical outcome was excellent, with no associated permanent neurological or neuropsychological morbidity. No recurrent cysts were observed over a mean follow-up period of 2 years and 3 months. CONCLUSIONS The contralateral approach to ventricular cysts can achieve excellent surgical outcomes while minimizing approach-related trauma to the dominant hemisphere. Careful case selection is essential to ensure that the contralateral endoscopic trajectory is the best possible exposure for sufficient cyst fenestration and restoration of CSF circulation.

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“…2,4,6,8,17) However, occlusion or stenosis of the ipsilateral ICA sometimes occurs after direct clipping and a high degree of mural sclerosis of the aneurysms and the parent artery is suspected to be one of the most crucial predictors of this phenomenon. 13,14,16,24) In our case, the severe calcification of the aneurysm neck led us to avoid direct clipping.…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances in skull base surgery have enabled direct clipping of the aneurysm. 2,4,6,8,13,17) The use of endovascular surgery has also increased, but the results of endosaccular coil embolization may be less satisfactory for wide-necked aneurysms or aneurysms causing a mass effect. 3,7,[9][10][11]14,[20][21][22][23] Direct clipping sometimes results in incomplete obliteration of the aneurysm or compromise of the patency of the ICA if severe sclerotic change is present in the wall of the aneurysm neck or the parent artery.…”

Section: Introductionmentioning

confidence: 99%

Large Paraclinoid Aneurysm With a Calcified Neck Treated by Tailored Multimodality Procedures-Case Report-

Kikuta

Miyamoto

Satow

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 68-year-old woman presented with a large paraclinoid aneurysm with a calcified neck causing visual symptoms. Direct clipping was hazardous because of severe calcification of the neck. Endovascular internal trapping was difficult because of the short distance between the neck and the origin of the posterior communicating artery. Proximal occlusion was likely to be less effective because of large collateral back flow to the aneurysm via the ophthalmic artery (OphA). The aneurysm was successfully treated by a combination of a high-flow bypass, intraoperative coil embolization of the parent artery including the origin of the OphA, and clipping of the internal carotid artery distal to the aneurysm. Paraclinoid aneurysms may be difficult to treat by the simple application of direct clipping, endovascular coiling, or trapping. Multimodality procedures can be tailored to treat such aneurysms.

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Contralateral and Ipsilateral Microsurgical Approaches to Carotid-Ophthalmic Aneurysms

Cited by 74 publications

References 24 publications

Endovascular Treatment of Paraclinoid Aneurysms

Endovascular Treatment of Paraclinoid Aneurysms

Endoscopic fenestration of intraventricular cerebrospinal fluid cysts: the contralateral approach

Large Paraclinoid Aneurysm With a Calcified Neck Treated by Tailored Multimodality Procedures-Case Report-

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