Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

Fujii, Takashi; Otani, Naoki; Takeuchi, Satoru; Toyo’oka, Toshimasa; Wada, Koichiro; Mori, Kentaro

doi:10.4103/sni.sni_169_17

Cited by 3 publications

(1 citation statement)

References 12 publications

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“… 5 However, postoperative complications such as mandibular dysfunction, chronic pain, and alterations in the facial sensory components frequently associated with temporal atrophy and injury of the frontal branch of the facial nerve and trigeminal branches have been reported. 6 7 8 As a result, constant modifications to the classical pterional approach have been done with the desire to reduce the volume of craniotomy, and also to reduce the traumatism caused during the intraoperative and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Justification of Extradural Resection of the Anterior Clinoid Process

Sufianov,

Iakimov,

Garifullina

et al. 2023

Asian J Neurosurg

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Objective The study aimed to provide neuroanatomical justification of the extradural resection of the anterior clinoid process (ACP). Material and Method Using a cross-sectional study design, 47 cranial computed tomography (CT) scans were examined. There were 31 (65.96%) females aged 28 to 79 years. The measured dimensions were ACP length and width, and optic strut (OS) width. Index (iacp) was measured as the ratio of ACP width to ACP length. The ACP volume and working operating field (WOF) volume were measured using Syngo.via Siemens program. The percentage expansion of WOF after removal of the ACP was estimated on 5 fixed human cadaver heads with the exoscope VITOM 3D. The possibilities of the combined approach were demonstrated in a clinical case. Results The mean ACP lengths were 11.31 ± 2.76 and 11.54 ± 2.86 mm, on the right and left, respectively. The mean ACP widths were 7.70 ± 1.66 and 7.64 ± 1.67 mm, on the right and left, respectively. Average iacp was 0.67 (minimum 0.45; maximum 0.90). The width of the OS varied in the range from 1.37 to 4.75 mm. The average volume of right ACP was 0.71 ± 0.16 cm3, right WOF was 3.26 ± 0.74 cm3, left ACP was 0.71 ± 0.15 cm3, left and WOF was 3.20 ± 0.76 cm3. Removal of the right ACP expanded the right WOF by 22.21 ± 3.88%, and left ACP by 22.78 ± 5.50%. There was an approximately 25% increase in the WOF from the cadaveric dissections. Taking into account the variability of the ACP and OS, we proposed our own surgical classification of complicated (iacp ≥ 0.67; medium OS 2.5 mm ≤ 4.0 mm; wide OS ≥ 4.0 mm; ACP with pneumatization) and uncomplicated ACP (iacp 0.45 ≤ 0.67 mm; iacp ≤ 0.45; narrow OS ≤ 2.5 mm; ACP without pneumatization). Using this classification, we developed an algorithm for ACP dissection and removal. This was piloted in a clinical case of microsurgical clipping of a left internal carotid artery-posterior communicating artery aneurysm via the left minipterional approach. Conclusion Extradural removal of ACP expands the WOF by approximately 25%, it helps neurosurgeons to improve proximal vascular control and avoid complications, and expands the range of indications for neurosurgical interventions in the skull base area.

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Section: Discussionmentioning

confidence: 99%

Anatomical Justification of Extradural Resection of the Anterior Clinoid Process

Sufianov,

Iakimov,

Garifullina

et al. 2023

Asian J Neurosurg

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The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory

Rim

Ahn²,

Park³

et al. 2023

Acta Neurochir

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Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature

Nussbaum¹,

Touchette²,

Madison³

et al. 2020

ONSURG

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BACKGROUND With advances in endovascular techniques, the relative roles of microsurgery and endovascular therapy in the management of intracranial aneurysms have become less clear, and data regarding treatment-specific outcomes are increasingly important. OBJECTIVE To describe our experience with microsurgery in a large series of unruptured anterior communicating artery aneurysms (ACOMMAAs) and detail our treatment decision-making process based on individual aneurysm morphology. METHODS We retrospectively reviewed unruptured ACOMMAAs treated microsurgically at our center between 1997 and 2018, recording aneurysm size, surgical approach, occlusion rates, neurological outcomes, and complications. RESULTS We treated 300 unruptured ACOMMAAs in 300 patients, mean age 49 yr, 180 (60.0%) female, including 245 (81.7%) small, 50 (16.7%) large, and 5 (1.7%) giant aneurysms. Most underwent a pterional approach (253, 84.3%), with orbitozygomatic or anterior interhemispheric approaches in 35 (11.7%) and 12 (4%), respectively. Greater than 95% occlusion was achieved in 284 (94.7%), 90% to 95% occlusion in 13 (4.3%), and 3 (1.0%) underwent wrapping. Serious complications occurred in 3 patients (1.0%) resulting in 2 deaths (0.7%), and minor complications in 12 (4.0%). At final follow-up, good neurological outcome was observed in 297 (99.0%) patients. CONCLUSION Given clinical equipoise regarding optimal treatment of unruptured ACOMMAAs, this work provides a benchmark for achievable microsurgical outcomes. Future surgical/endovascular studies should separate results of ruptured and unruptured lesions and describe aneurysm morphology to allow for better comparison of outcomes between treatments. We suggest that open microsurgery represents an important option for select, morphologically complex ACOMMAAs, and that a multidisciplinary approach offers optimal patient outcomes.

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Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

Cited by 3 publications

References 12 publications

Anatomical Justification of Extradural Resection of the Anterior Clinoid Process

Anatomical Justification of Extradural Resection of the Anterior Clinoid Process

The risk factors of postoperative infarction after surgical clipping of unruptured anterior communicating artery aneurysms: anatomical consideration and infarction territory

Microsurgical Treatment of Unruptured Anterior Communicating Artery Aneurysms: Approaches and Outcomes in a Large Contemporary Series and Review of the Literature

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