Conventional microsurgical treatment of paraclinoid aneurysms: state of the art with the use of the selective extradural anterior clinoidectomy SEAC

Khan, Nadia; Yoshimura, Shinichi; Roth, Peter; Cesnulis, Evaldas; Koenue-Leblebicioglu, D.; Curcic, M; Imhof, Hans-Georg; Yonekawa, Yasuhiro

doi:10.1007/3-211-27911-3_5

Cited by 33 publications

(23 citation statements)

References 35 publications

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“…These findings are within the range of previous surgical (0–2.7%)32 33 and endovascular (1.3–2.2%) series11 12 focusing on unruptured aneurysms. In one microsurgical patient (small blood blister-like ophthalmic aneurysm), intraoperative aneurysm rupture resulted in temporary ICA trapping and intraoperative manipulation of the optic pathway.…”

Section: Discussionsupporting

confidence: 86%

Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy

Sherif

Gruber

Dorfer

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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Based on favourable neuroradiological and ophthalmological outcomes, microsurgery is recommended for superiorly projecting aneurysms, especially aneurysms involving the ophthalmic artery, and for giant/large or wide necked aneurysms. Based on stable aneurysm occlusion and excellent clinical outcomes, embolisation can be recommended for inferiorly/medially projecting small, narrow necked aneurysms.

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Section: Discussionsupporting

confidence: 86%

Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy

Sherif

Gruber

Dorfer

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…For the proper access to the aneurysm and the corresponding carotid segment, bone removal is also required, whose extent is determined by the lower end of the neck orifice and the size of the aneurysm, and it is larger in big and giant aneurysms. Selective clinoidectomy for clipping of ‘carotid cave’ aneurysms had reported excellent 10-year results [38]. The amount of drilling can be planned on the preoperative 3-dimensional CT angiography with and without bone subtraction.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a Simplified Management Scheme for Paraclinoid Aneurysms Based on a Modified Classification

et al. 2008

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Background: Our objective was to set up a management-oriented classification for paraclinoid aneurysms, and then design and apply a simplified management scheme according to each group defined by this classification. Methods: Paraclinoid aneurysms were classified as group I (supraophthalmic artery), group II (ophthalmic artery) and group III (infraophthalmic artery) aneurysms intradurally. Between January 2005 and December 2006, 86 cases with 89 paraclinoid aneurysms were treated. There were 35 (40.2%) aneurysms in group I (20 in group Ia, 15 in group Ib), 32 (36.8%) in group II and 20 (23%) in group III. Results: In group I aneurysms, 20 (57.1%) were treated by clipping or/and wrapping, while 15 (42.9%) were managed by coiling. In group II aneurysms, 20 (62.5%) were treated by clipping and 12 (37.5%) by coiling. The contralateral approach was performed for 4 (6%) aneurysms in groups I and II. All 20 group III aneurysms were treated by coiling. The overall rate of permanent complications was 4.6%. The rate of complete occlusion was 92.5% in surgical cases and 55.6% in endovascular ones. The overall outcomes in the treatment of paraclinoid aneurysms were excellent (GOS = 5, 95.4%). Conclusion: Based on our modified classification of paraclinoid aneurysms, a simplified management scheme was designed and applied. For group I (supraophthalmic artery) and group II (ophthalmic artery) aneurysms, surgical clipping or/and wrapping should be the first choice of treatment, while for group III (infraophthalmic artery) aneurysms, endovascular coiling should be the best modality. Additionally, individualizing the treatment planning might contribute to better results.

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“…Aneurysms arising from the proximal part of the internal carotid artery (ICA) between its exit from the proximal dural ring (oculomotor membrane) and proximal to the origin of the posterior communicating artery have been collectively termed paraclinoid aneurysms18,19,21). These paraclinoid aneurysms are classified based on complex relationships between the aneurysm sac, dura, branching arteries, and anterior clinoid process2,3,8,14,18,19,28,29).…”

Section: Introductionmentioning

confidence: 99%

“…These paraclinoid aneurysms are classified based on complex relationships between the aneurysm sac, dura, branching arteries, and anterior clinoid process2,3,8,14,18,19,28,29). Advancements in endovascular and microsurgical techniques have substantially improved the completeness of aneurysm sac obliteration operations and the treatment outcomes of paraclinoid aneurysms5,8,9,15,16,18,30,33,35,39). However, because of the incredibly complex neuroanatomical relationship between bone, neural, and vascular structures around this paraclinoid area evidenced by high rates of surgical morbidity and mortality, direct microsurgical occlusion for large and giant paraclinoid aneurysms have remained a great challenge for vascular neurosurgeons.…”

Section: Introductionmentioning

confidence: 99%

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Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

Lee

Kim

2013

J Korean Neurosurg Soc

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ObjectiveAlthough surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications.MethodsBetween September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography.ResultsOf the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely.ConclusionThe key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.

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Conventional microsurgical treatment of paraclinoid aneurysms: state of the art with the use of the selective extradural anterior clinoidectomy SEAC

Cited by 33 publications

References 35 publications

Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy

Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy

Usefulness of a Simplified Management Scheme for Paraclinoid Aneurysms Based on a Modified Classification

Internal Carotid Artery Reconstruction Using Multiple Fenestrated Clips for Complete Occlusion of Large Paraclinoid Aneurysms

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