Direct Clipping of Paraclinoid Aneurysm in Conjunction with Extradural Anterior Clinoidectomy: Technical Nuance and Functional Outcome

2021 ◽  
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue ◽  
Naoko Takeuchi ◽  
Atsuya Akabane ◽  
Nobuhito Saito
Keyword(s):  
Muscle Atrophy ◽  
Surgical Stress ◽  
Chronic Phase ◽  
Executive Dysfunction ◽  
Temporalis Muscle ◽  
Brain Contusion ◽  
Anterior Clinoidectomy ◽  
Surgical Method ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms

Abstract Objective Because of their anatomical features, treatment for paraclinoid aneurysms has remained to be challenging. Thus, the aim of this report is to prove the validity of our surgical method for unruptured paraclinoid aneurysms, together with surgical videos. Study Design Between August 2017 and November 2019, we were able to perform surgical clipping for 11 patients with unruptured paraclinoid aneurysm using a completely unified method. This study investigated the effect of surgery on multiple measures, including visual impairment, brain contusion, temporalis muscle atrophy, and multiple neurocognitive functions. Results Of the 67 unruptured aneurysms treated at our hospital, 17 were identified to be paraclinoid aneurysm, and 11 of them were treated by direct clipping using anterior clinoidectomy. Three were ophthalmic artery aneurysms, three were superior hypophyseal artery aneurysms, and five were anterior carotid wall aneurysms without branch projection. Only one patient had asymptomatic mild enlargement of the Marriott blind spots postoperatively. No brain contusion and temporalis muscle atrophy were observed in any cases. Only the Trail Making test (TMT) showed a significant worsening in the acute postoperative period: mean pre- and postoperative TMT scores were 59.1 ± 29.1 and 72.7 ± 37.3 for Part A (p = 0.018) and 80.5 ± 35.5 and 93.8 ± 39.9 for Part B (p = 0.030), respectively. However, it improved in the chronic phase. Conclusion We can conclude that our surgical method is safe and can be considered an acceptable treatment. Although surgical stress can cause temporary executive dysfunction shortly after surgery, this decline is temporary.

scholarly journals Surgically Relevant Bony Anatomical Variations in Paraclinoid Aneurysms-Three-Dimensional Multi-Detector Row Computed Tomography-Based Study

2017 ◽  
Vol 08 (03) ◽  
pp. 330-334 ◽  
Author(s):  
K. Suprasanna ◽  
Ashvini Kumar
Keyword(s):  
Computed Tomography ◽  
Cerebral Angiography ◽  
Three Dimensional ◽  
Anatomical Variations ◽  
Type I ◽  
Anterior Clinoid Process ◽  
Multiplanar Reconstructions ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Caroticoclinoid Foramen

ABSTRACT Objective: To evaluate the proportion of surgically relevant anatomical variations such as caroticoclinoid foramen, interclinoid osseous bridge, and anterior clinoid pneumatization in patients with paraclinoid aneurysms based on computed tomography (CT) cerebral angiography studies. Materials and Methods: Fifty-four CT cerebral angiography studies showing paraclinoid aneurysms involving the cavernous, clinoid, and supraclinoid internal carotid artery (ICA) were retrospectively evaluated. Source images were processed for three-dimensional reconstructions to evaluate the presence and type of caroticoclinoid foramen, interclinoid osseous bridge, and multiplanar reconstructions with bone algorithm to study the type of pneumatization. Results: The study included 30 female and 24 male patients with mean age of 45.61 (10.47) years. Among the 108 sides studied in 54 patients, caroticoclinoid foramen was seen in 24 cases (22.22%), interclinoid osseous bridge was seen unilaterally in 1 case (0.9%), and pneumatization of anterior clinoid process occurred in 12 cases (11.11%). Incomplete caroticoclinoid foramen (11 cases) and Type I pneumatization (7 cases) were seen to be predominant subtypes. There was no statistically significant gender difference in the occurrence of caroticoclinoid foramen and anterior clinoid pneumatization. Seventy-four aneurysms were detected in 54 patients. Based on their location, 46 aneurysms involved supraclinoid ICA, 18 aneurysms in the clinoid segment, and 10 aneurysms in the cavernous segment. Caroticoclinoid foramen was most prevalent in clinoid aneurysms with 12 cases occurring in the clinoid segment. Conclusion: Notable proportions of caroticoclinoid foramen and pneumatization occur in cases of paraclinoid aneurysm. Radiological reports should emphasize on these surgically relevant bony anatomical variations.

Relationship between the ophthalmic artery and the dural ring of the internal carotid artery

2009 ◽  
Vol 111 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Tetsuyoshi Horiuchi ◽  
Yuichiro Tanaka ◽  
Yoshikazu Kusano ◽  
Takehiro Yako ◽  
Tetsuo Sasaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Medial Side ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Ophthalmic Arteries

Object The ophthalmic artery (OphA) usually arises from the intradural internal carotid artery (ICA), and the extradural origin has also been known. However, the interdural origin is extremely rare. The purpose of this paper was to clarify the origin of the OphA in patients with a paraclinoid aneurysm in the ICA based on intraoperative findings. Methods The authors retrospectively examined 156 patients who underwent direct surgical treatment for 166 paraclinoid aneurysms during a 17-year period. Based on intraoperative findings, 119 ophthalmic arteries were analyzed with respect to their origins. Results The OphA originated from the intradural ICA on 102 sides (85.7%), extradural on 9 (7.6%), and interdural on 8 (6.7%). Although the extradural origin might be recognized preoperatively, it was difficult to distinguish the interdural origin of the OphA from the intradural one. Conclusions The incidence of the interdural origin was 6.7% and was not as rare as the authors expected. Neurosurgeons should know the possible existence of the interdural origin of the OphA to section the medial side of the dural ring.

Anterior Clinoidectomy and Opening of the Internal Auditory Canal Using an Ultrasonic Bone Curette

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 867-871 ◽  
Author(s):  
Hiromu Hadeishi ◽  
Akifumi Suzuki ◽  
Nobuyuki Yasui ◽  
Yuichirou Satou
Keyword(s):  
High Speed ◽  
Longitudinal Vibration ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Ultrasonic Frequency ◽  
Surgical Equipment ◽  
Anterior Clinoidectomy ◽  
Paraclinoid Aneurysm ◽  
Controlled Irrigation ◽  
Cranial Base Surgery

Abstract OBJECTIVE During cranial base surgery, use of a high-speed drill for osteotomy has become common. We performed anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette, and we report the advantages and clinical applications of this method. DESCRIPTION OF INSTRUMENTATION The ultrasonic surgical equipment comprises a power supply unit, footswitch, and handpiece (weight, 110 g; diameter, 20 mm; length, 140 mm from tip to angled section). The handpiece tip is 2 mm wide, and the amplitude of longitudinal vibration can be varied from 120 to 365 μm at an ultrasonic frequency of 25 kHz. Cool-controlled irrigation fluid emerges near the tip, through the sheath. EXPERIENCE AND RESULTS We performed anterior clinoidectomy in eight cases of paraclinoid aneurysm and opening of the internal auditory canal in six cases of acoustic neuroma without damage to the dura mater or nearby structures such as brain tissue, blood vessels, and cranial nerves. In addition, no damage to the facial nerve or labyrinthine organ resulted from heat or vibration caused by the ultrasonic bone curette. CONCLUSION Ultrasonic bone curettage represents safe instrumentation for performance of anterior clinoidectomy and opening of the internal auditory canal without damage to surrounding structures. This technique allows surgeons to perform procedures on deep areas without incurring psychomotor stress.

scholarly journals Microsurgical clipping of paraclinoid aneurysms

2020 ◽  
pp. 31-40
Author(s):  
Mugurel Radoi ◽  
Ram Vakilnejad ◽  
Suditu Stefan ◽  
Florin Stefanescu
Keyword(s):  
Endovascular Coiling ◽  
Parent Artery ◽  
Excellent Outcome ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysm ◽  
Postoperative Control ◽  
Paraclinoid Aneurysms ◽  
Operative Control ◽  
Ophthalmic Segment Aneurysms

Background. Paraclinoid aneurysm is a nonspecific term that includes ophthalmic segment aneurysms and distal cavernous internal carotid artery (ICA) aneurysms. The literature mostly described the frequency to be in the range of 1.3-5%. and a high incidence of being multiple or having a large size. Methods. A retrospective review of 18 consecutive patients surgically treated for paraclinoid aneurysm was performed. The data of all our consecutive patients were searched to obtain patient and aneurysm characteristics, treatment details, complications and follow up. Clinical outcome was graded according to the modified Rankin scale. The follow-up period varied widely from 3 to 62 months (mean 26 months). Results. Surgical clipping was performed for 15 ruptured paraclinoid aneurysms; only in 3 cases the aneurysm was unruptured. Post-operative control angiography was performed in 10 patients (55.56%), from which we reported a full occlusion of the aneurysm in 9 patients (90%). Best results were obtained in patients who preoperatively were included in 1st and 2nd grade of Hunt & Hess scale. Two months postoperative follow-up was complete for all but one patient who died 12 days after surgery, from cerebral ischemia resulting from severe cerebral vasospasm. There were excellent and good results (mRS 0–2) in 88% of the cases (15 out of 17 patients) at two months follow-up, and 94% (16 out of 17 patients) at six months follow-up. Three patients with slight disabilities, ranked mRS 1-2 at two months follow-up, improved to mRS 0, with no symptoms at all, at 6 months postoperative control. All 3 patients with a surgically treated non-ruptured paraclinoid aneurysm had an excellent outcome (mRS 0). Conclusions. Most appropriate treatment is to occlude aneurysms without compromising patency of the parent artery. Anterior clinoidectomy and microsurgical clipping can still be a standard treatment despite of recent development of endovascular coiling procedures.

scholarly journals Long-Term Use and Perceived Benefits of Goal-Oriented Attentional Self-Regulation Training in Chronic Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Fred Loya ◽  
Tatjana Novakovic-Agopian ◽  
Deborah Binder ◽  
Annemarie Rossi ◽  
Scott Rome ◽  
...  
Keyword(s):  
Brain Injury ◽  
Self Regulation ◽  
Intervention Development ◽  
Chronic Phase ◽  
Executive Dysfunction ◽  
Primary Objective ◽  
Strategy Use ◽  
Functional Changes ◽  
Perceived Benefit

Primary Objective. To investigate the long-term use and perceived benefit(s) of strategies included in Goal-Oriented Attentional Self-Regulation (GOALS) training (Novakovic-Agopian et al., 2011) by individuals with acquired brain injury (ABI) and chronic executive dysfunction. Research Design. Longitudinal follow-up of training. Methods and Procedures. Sixteen participants with chronic ABI participated in structured telephone interviews 20 months (range 11 to 31 months) following completion of GOALS training. Participants responded to questions regarding the range of strategies they continued to utilize, perceived benefit(s) of strategy use, situations in which strategy use was found helpful, and functional changes attributed to training. Results. Nearly all participants (94%) reported continued use of at least one trained strategy in their daily lives, with 75% of participants also reporting improved functioning resulting from training. However, there was considerable variability with respect to the specific strategies individuals found helpful as well as the perceived impact of training on overall functioning. Conclusions. GOALS training shows promising long-term benefits for individuals in the chronic phase of brain injury. Identifying individual- and injury-level factors that account for variability in continued strategy use and the perceived long-term benefits of training will help with ongoing intervention development.

Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy

1996 ◽  
Vol 84 (2) ◽  
pp. 297-299 ◽  
Author(s):  
Susumu Oikawa ◽  
Masahiko Mizuno ◽  
Shinsuke Muraoka ◽  
Shigeaki Kobayashi
Keyword(s):  
Muscle Atrophy ◽  
Simple Technique ◽  
Temporalis Muscle ◽  
Content Type ◽  
Pterional Craniotomy ◽  
Less Invasive ◽  
Fine Print

✓ A procedure for preventing muscle atrophy in pterional craniotomy by temporalis muscle dissection is described, along with anatomical considerations. The inferior to superior dissection of the temporalis muscle is a very simple technique and is less invasive than other approaches.

Music-supported systematic treatment strategy for patients with executive dysfunction following traumatic brain injury: Similarities and divergencies in 7 case reports.

2019 ◽  
Vol 11 (3) ◽  
pp. 166
Author(s):  
Berit Marie Dykesteen Vik
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Present Article ◽  
Case Reports ◽  
Chronic Phase ◽  
Executive Dysfunction ◽  
Specific Information ◽  
Post Intervention ◽  
Systematic Treatment ◽  
Case Study Methodology

AbstractThis article explores what factors may predict a positive or negative outcome for cognitive enhancement and improved social behaviour after music-supported intervention for patients with cognitive and behavioural deficits following mild traumatic brain injury (mTBI). 7 patients with executive dysfunction following mTBI participated in a music-based intervention. They were in a chronic phase and were either sicklisted or worked part-time. 6 out of 7 participants returned to work post-intervention. Results from neurophysiological tests and fMRI consolidated with enhanced cognitive performance and functional neuroplasticity in orbitofrontal cortex.  However, these result were based on quantitative analysis with mean effect and did not give specific information about similarities and divergencies between the participants which may have an impact on the final outcome. The present article applies a case-study methodology and explores behavioural data obtained from the study, not earlier published. This methodology  allows an in depth analyse of  clinical data, observational data during intervention and data from semi-structured interviews pre-post intervention. Aim of the present article is to develop a systematic treatment strategie of music training to improve cognitive and behavioral domains of functioning in patients with cognitive deficits following mTBI.

Anterior paraclinoid aneurysms

2002 ◽  
Vol 96 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Kazuo Mizoi ◽  
Yoshihide Nagamine ◽  
Noritaka Yanagida ◽  
Shigeki Mikawa ◽  
...  
Keyword(s):  
Special Group ◽  
Anterior Clinoid Process ◽  
Dorsal Wall ◽  
Content Type ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Proximal Internal Carotid Artery ◽  
Female Predominance ◽  
Intradural Space ◽  
Fine Print

Object. The characteristics of a previously unclassified paraclinoid aneurysm arising from the anterolateral (dorsal) wall of the proximal internal carotid artery were retrospectively analyzed in seven patients (five women and two men) who were treated surgically for an aneurysm in this unusual location. Methods. One patient presented with subarachnoid hemorrhage (SAH) caused by rupture of this aneurysm. The lesions were found incidentally (five cases) or during investigation of SAH due to another aneurysm (one case). There was a female predominance in this series; all female patients harbored multiple aneurysms. All patients underwent surgery. Removal of the anterior clinoid process was necessary because the proximal neck of the aneurysm was closely adjacent to the dural ring. Conclusions. This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.

Novel Use of an Endovascular Embolectomy Device for Retrograde Suction Decompression-Assisted Clip Ligation of a Large Paraclinoid Aneurysm: Technical Case Report

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS412-ONS413 ◽  
Author(s):  
Daniel J. Hoh ◽  
Donald W. Larsen ◽  
James B. Elder ◽  
Paul E. Kim ◽  
Steven L. Giannotta ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Computed Tomographic Angiography ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Intraoperative Angiography ◽  
Paraclinoid Aneurysm ◽  
Surgical Clip ◽  
Paraclinoid Aneurysms

Abstract Objective: Several different methodologies for proximal occlusion and retrograde suction decompression of large paraclinoid aneurysms have been reported previously. In this article, we describe the novel use of an endovascular embolectomy device (F.A.S.T. funnel catheter; Genesis Medical Interventional, Inc., Redwood City, CA) for temporary internal carotid artery occlusion and suction decompression of an intracranial aneurysm to facilitate surgical clip ligation. The combination of atraumatic occlusion technology and large lumen size makes this technique safer and easier. Clinical Presentation: A 53-year-old woman with progressive headaches underwent computed tomographic angiography, which revealed an unruptured large left paraclinoid aneurysm. Cerebral angiography confirmed the diagnosis. The patient did not tolerate a balloon test occlusion for therapeutic Hunterian internal carotid occlusion. The patient was subsequently taken to the operating room for a craniotomy and clip ligation of the aneurysm. Intervention: A standard left pterional craniotomy was performed with opening of the sylvian fissure and exposure of the left paraclinoid aneurysm. Intraoperative angiography with introduction of a new endovascular embolectomy device was performed. The device was deployed to achieve temporary occlusion of the cervical internal carotid artery, and aspiration through the central lumen allowed for retrograde suction decompression of the aneurysm. Collapse of the aneurysm through this technique permitted visualization of the aneurysmal neck with successful clip ligation. Conclusion: A new endovascular embolectomy device can be used to safely perform suction decompression of large paraclinoid aneurysms to facilitate clip ligation.

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