Contralateral pterional approach to a carotid-ophthalmic aneurysm ruptured at surgery

Milenković, Zoran; Gopić, H; Antović, P; Jovicić,; Petrović, B

doi:10.3171/jns.1982.57.6.0823

“…There are only a few reports about surgical treatment of contralateral aneurysms [6,21,22] besides the contralateral approach for some types of carotid ophthalmic aneurysms [8,9,11,24,28]. We believe that the ideal treatment for multiple aneurysms should be radical single-stage surgery for all aneurysms including, if possible, the ones arising on the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

Anatomical and technical aspects of the contralateral approach for multiple aneurysms

Oliveira

¹

,

Tedeschi

²

,

Siqueira

³

et al. 1996

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Microsurgery of multiple aneurysms is still a controversial subject. In order to avoid the risk of rebleeding and the consequent increase in morbidity in such cases all aneurysms or at least as many aneurysms as possible should be treated in the first operative procedure. To reach that goal aneurysms located on the contralateral side should also be considered for clipping during the first operation. Between 1984 and 1994 a series of 51 patients harboring multiple aneurysms of which 55 aneurysms were located on the contralateral side of the craniotomy were operated at our institution. No mortality or morbidity could be directly ascribed to the aneurysm that was clipped contralaterally. Based on that series we have described the anatomical features, technical aspects and surgical difficulties of approaching bilateral aneurysms through the same craniotomy.

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“…Nakao, et al, 8 Milenkovic, et al, 7 Nishio, et al, 9 and Yamada, et al, 14 have described the contralateral surgical approach to obliterate medially projecting OA aneurysms. Nakao, et al, 8 Milenkovic, et al, 7 Nishio, et al, 9 and Yamada, et al, 14 have described the contralateral surgical approach to obliterate medially projecting OA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study

Oshiro

¹

,

Rini²,

Tamargo³

1997

Journal of Neurosurgery

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In patients with bilateral supratentorial aneurysms, surgical clipping of all aneurysms via a unilateral approach would obviate the need for a second operation. The authors conducted a microsurgical study in human cadaver heads to examine the contralateral exposure for four common aneurysm sites in the anterior circulation: the ophthalmic artery (OA) origin, the posterior communicating artery (PCoA) origin, the internal carotid artery (ICA) termination, and the middle cerebral artery (MCA) bifurcation. Frontotemporal craniotomies were performed in 16 cadavers to evaluate the corridor for exposure of these sites from the contralateral side. Morphometric data, including lengths and diameters of major arterial segments and optic nerves, were documented for anatomical correlation. In this study, the contralateral OA origin was successfully exposed in 62% of specimens, the PCoA origin in 50%, the ICA bifurcation in 100%, and the MCA bifurcation in 62%. Exposure of the OA origin and, in some cases, the PCoA, required incision of the falciform ligament and mobilization of the contralateral optic nerve. Exposure of the MCA bifurcation was dependent on the length of the M1 segment, with successful exposure only when this segment was shorter than 14 mm. Implications for the contralateral approach to aneurysms at these sites are discussed and the microsurgical corridors for exposure are described. For correlation with the anatomical study, a brief clinical review of patients with bilateral supratentorial aneurysms treated at The Johns Hopkins Hospital between 1992 and 1995 is presented. Guidelines for the contralateral approach to aneurysms are discussed with reference to the anatomical study and the clinical review.

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“…Although the contralateral frontotemporal approach to anterior circulation aneurysms has been described in previous studies, clear guidelines with respect to microsurgical anatomical corridors of approach have not been established. Nakao, et al, [8] Milenkovic, et al, [7] Nishio, et al, [9] and Yamada, et al, [14] have described the contralateral surgical approach to obliterate medially projecting OA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study

Oshiro¹,

Rini²,

Tamargo³

1997

FOC

View full text Add to dashboard Cite

In patients with bilateral supratentorial aneurysms, surgical clipping of all aneurysms via a unilateral approach would obviate the need for a second operation. The authors conducted a microsurgical study in human cadaver heads to examine the contralateral exposure for four common aneurysm sites in the anterior circulation: the ophthalmic artery (OA) origin, the posterior communicating artery (PCoA) origin, the internal carotid artery (ICA) termination, and the middle cerebral artery (MCA) bifurcation. Frontotemporal craniotomies were performed in 16 cadavers to evaluate the corridor for exposure of these sites from the contralateral side. Morphometric data, including lengths and diameters of major arterial segments and optic nerves, were documented for anatomical correlation. In this study, the contralateral OA origin was successfully exposed in 62% of specimens, the PCoA origin in 50%, the ICA bifurcation in 100%, and the MCA bifurcation in 62%. Exposure of the OA origin and, in some cases, the PCoA, required incision of the falciform ligament and mobilization of the contralateral optic nerve. Exposure of the MCA bifurcation was dependent on the length of the M1 segment, with successful exposure only when this segment was shorter than 14 mm. Implications for the contralateral approach to aneurysms at these sites are discussed and the microsurgical corridors for exposure are described. For correlation with the anatomical study, a brief clinical review of patients with bilateral supratentorial aneurysms treated at The Johns Hopkins Hospital between 1992 and 1995 is presented. Guidelines for the contralateral approach to aneurysms are discussed with reference to the anatomical study and the clinical review.

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Contralateral pterional approach to a carotid-ophthalmic aneurysm ruptured at surgery

Cited by 44 publications

References 9 publications

Anatomical and technical aspects of the contralateral approach for multiple aneurysms

Anatomical and technical aspects of the contralateral approach for multiple aneurysms

Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study

Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study

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