Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery

1989 ◽  
Vol 99 (3-4) ◽  
pp. 117-121 ◽  
Author(s):  
Ch. Ochiai ◽  
S. Wakai ◽  
S. Inou ◽  
M. Nagai
Keyword(s):  
Internal Carotid ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Anterior Clinoid Process ◽  
Posterior Communicating Artery Aneurysm

Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process

2002 ◽  
Vol 96 (4) ◽  
pp. 788-791 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Katsuya Futawatari ◽  
Kazuo Mizoi ◽  
Naoki Higashiyama ◽  
Hisashi Kojima ◽  
...  
Keyword(s):  
Visual Field ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Operating Microscope ◽  
Aneurysm Surgery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Endoscopic Guidance ◽  
Posterior Communicating Artery Aneurysm ◽  
Fine Print

✓ A 47-year-old man presented with a superior hypophyseal artery aneurysm and an ipsilateral posterior communicating artery aneurysm. Both lesions were successfully clipped without removal of the anterior clinoid process or retraction of the optic nerve by using endoscopic guidance. The endoscope was introduced into the prechiasmatic cistern and provided a clear visual field around the aneurysm that could not be seen via the operating microscope. The endoscope was useful in the identification of the medially projecting lesion and the small perforating branches of the ophthalmic segment of the internal carotid artery. A fenestrated clip could be introduced around the neck of the aneurysm and placed in the best position under endoscopic guidance. Endoscopy-assisted clipping is potentially a very useful procedure for aneurysm surgery.

PREOPERATIVE PREDICTIVE VALUE OF THE NECESSITY FOR ANTERIOR CLINOIDECTOMY IN POSTERIOR COMMUNICATING ARTERY ANEURYSM CLIPPING

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. 281-286 ◽  
Author(s):  
Sang Kyu Park ◽  
Yong Sam Shin ◽  
Yong Cheol Lim ◽  
Joonho Chung
Keyword(s):  
Predictive Value ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Computed Tomographic Angiography ◽  
Posterior Communicating Artery ◽  
P Value ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Computed Tomographic ◽  
Posterior Communicating Artery Aneurysm

Abstract OBJECTIVE Resection of the anterior clinoid process (ACP) for the clipping of an internal carotid–posterior communicating artery aneurysm is rarely needed. However, preoperative awareness of the necessity of anterior clinoidectomy is essential for safe clipping of the lesions. We investigated the preoperative predictive value for anterior clinoidectomy in treating internal carotid–posterior communicating artery aneurysms. METHODS We retrospectively reviewed all patients with a posterior communicating artery aneurysm treated with clipping in the past 5 years. Only the patients who underwent both computed tomographic angiography and 4-vessel digital subtraction angiography were included in this study. We measured several angles and distances on these images, and compared the parameters measured between an anterior clinoidectomy group and a non–anterior clinoidectomy group. A P value of less than 0.05 was considered significant. RESULTS We examined 94 cases of posterior communicating artery aneurysms treated with clipping. The ACP was resected in 6 of the 94 cases. In the anterior clinoidectomy group, there were 3 factors that were statistically significant. First, the calculated real distance between the ACP and the aneurysmal neck was shorter (mean, 4.4 ± 0.7 versus 7.2 ± 1.4 mm). Second, the angle between vertical line to cranial base and communicating segment of the internal carotid artery (ICA) was larger (mean, 62.5 ± 4.6 versus 50.9 ± 10.7 degrees). Third, the angle between the communicating segment and the ophthalmic segment of the ICA was smaller (mean, 66.5 ± 15.1 versus 84.6 ± 20.4 degrees). CONCLUSION The anterior clinoidectomy group showed a more tortuous course of intracranial ICA around the ACP than the nonclinoidectomy group. Therefore, measurement of the distal ICA angle is helpful in predicting the necessity of anterior clinoidectomy.

An Operative Complication in a Patient with a True Posterior Communicating Artery Aneurysm: Case report and Review of the Literature

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 650-653 ◽  
Author(s):  
Tadashi Kudo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Review Of The Literature ◽  
Operative Complications ◽  
Posterior Communicating Artery Aneurysm ◽  
Aneurysmal Neck

Abstract Intraoperative oculomotor nerve injury in a patient with a true posterior communicating artery aneurysm is reported in detail. A comparison of internal carotid artery aneurysms at the posterior communicating artery junction with true posterior communicating artery aneurysms deserves special attention, because the vascular relationships of the aneurysm are more complex. A clip along the internal carotid artery does not occlude blood flow to the aneurysm, and the aneurysmal neck and the distal posterior communicating artery are closer to the oculomotor nerve. This is the 27th reported case of a true posterior communicating artery aneurysm. The incidence of true posterior communicating artery aneurysms ranges from 0.1 to 2.8% of all aneurysm patients. Such aneurysms constitute 4.6 and 11% of so-called posterior communicating aneurysms in two series. Difficulty associated with a preoperative diagnosis has been documented in at least 4 cases. An awareness of this rare aneurysm is stressed in order to avoid operative complications.

scholarly journals Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: A case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 353
Author(s):  
Hirotaka Inoue ◽  
Akihito Hashiguchi ◽  
Koichi Moroki ◽  
Hajime Tokuda
Keyword(s):  
Internal Carotid ◽  
Artery Aneurysm ◽  
Underlying Mechanism ◽  
Nerve Fibers ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Age Related ◽  
Posterior Communicating Artery Aneurysm ◽  
Multiple Fibers ◽  
Loss Of Compactness

Background: Although it is well known that internal carotid-posterior communicating artery (ICA-PcomA) aneurysms compress the oculomotor nerve and cause nerve palsy, cases of ICA-PcomA aneurysms splitting the oculomotor nerve are extremely rare. Case Description: We present the rare case of an asymptomatic, growing, left-sided ICA-PcomA aneurysm that was confirmed to split the oculomotor nerve. We report the clinical course and discuss the underlying mechanism. The oculomotor nerve, which is an aggregate of multiple fibers, exhibits age-related loss of compactness in the arrangement of its nerve fibers. Conclusion: We speculate that injury to the nerve fibers by aneurysmal compression was avoided because of the rare phenomenon of splitting of the oculomotor nerve.

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