scholarly journals Morphometric Comparison of the Pterional Trans-sylvian and the Pretemporal Transclinoidal Approaches to Posterior Communicating Artery Aneurysms: Anatomical Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jaafar Basma ◽  
Kenneth Moore ◽  
Tarek Abuelem ◽  
Khaled Krisht ◽  
L Madison Michael ◽  
...  
Keyword(s):  
Clinical Case ◽  
Internal Carotid ◽  
Focal Point ◽  
Anatomical Study ◽  
Pterional Approach ◽  
Case Examples ◽  
Pterional Craniotomy ◽  
Working Space ◽  
Area 5 ◽  
Ischemic Complications

Abstract INTRODUCTION Due to the advent of endovascular techniques, modern series of surgically treated posterior communicating (Pcom) aneurysms have shown a tendency towards higher complexity and more technical difficulties. The pretemporal approach was described as a valuable extension to the pterional approach in treating basilar apex aneurysms. Its use for clipping of ruptured Pcom aneurysms was associated with decreased ischemic complications. However, its anatomical advantages for Pcom aneurysm surgery have not been previously analyzed. METHODS Six cadaveric heads (12 sides) underwent a sequential dissection, starting with a pterional craniotomy, and then extended to a pretemporal transclinoidal approach. In each step, the following variables were measured, taking the origin of Pcom as a focal point: (1) exposed length of the internal carotid artery (ICA) proximal to the Pcom artery, (2) exposed angular circumference of ICA at the origin of Pcom, (3) deep working area between the optic nerve and tentorium/oculomotor nerve, (4) superficial working area, (5) depth of the exposure and the (6) fronto-temporal (superior posterolateral), and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. Clinical case examples are used to illustrate the advantages of the pretemporal approach. RESULTS Compared to the pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P = .0001), and its circumference from 5.1 to 7.8 mm (P = .0003), allowing a 210-degree view of the ICA (vs 137.9). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P = .0048) and 252.8 to 418.2 mm2 (P = .0001), respectively; while the depth of the exposure was equivalent. The frontotemporal and the sphenosylvian angles increased on average by 17 (P = .0006) and 10 (P = .0037) degrees, respectively. The clinical case examples demonstrate the visual, technical and strategic advantages of the pretemporal approach as a consequence of its anatomical exposure. CONCLUSION The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, aneurysm visualization, and more versatile clipping angles. The enhanced exposure potentially results in a higher rate of complete aneurysm obliteration and complication avoidance.

Morphometric Comparison of the Pterional Trans-Sylvian and the Pretemporal Trans-Clinoidal Approaches to the Posterior Communicating Artery

2020 ◽  
Vol 20 (1) ◽  
pp. E22-E30
Author(s):  
Jaafar Basma ◽  
Kenneth A Moore ◽  
Khaled Krisht ◽  
Tarek Abuelem ◽  
Kenan Arnautovic ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Pterional Approach ◽  
Pterional Craniotomy ◽  
Working Space ◽  
Area 5 ◽  
Modern Era

Abstract BACKGROUND Posterior communicating (Pcom) aneurysms in the modern era have tended toward increased complexity and technical difficulties. The pretemporal approach is a valuable extension to the pterional approach for basilar apex aneurysms, but its advantages for Pcom aneurysms have not been previously elucidated. OBJECTIVE To quantify characteristics of the pretemporal approach to the Pcom. METHODS We dissected 6 cadaveric heads (12 sides) with a pretemporal transclinoidal approach and measured the following variables: (1) exposed length of internal carotid artery (ICA) proximal to the Pcom artery; (2) exposed circumference of ICA at the origin of Pcom; (3) deep working area between the optic nerve and tentorium/oculomotor nerve; (4) superficial working area; (5) exposure depth; and (6) the frontotemporal (superior posterolateral) and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. RESULTS Compared with pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P = .0001) and its circumference from 5.1 to 7.8 mm (P = .0003), allowing a 210° view of the ICA (vs 137.9°). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P = .0048) and 252.8 to 418.2 mm2 (P = .0001), respectively; the depth of the exposure was equivalent. The frontotemporal and spheno-Sylvian angles increased by 17° (P = .0006) and 10° (P = .0037), respectively. CONCLUSION The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, improved aneurysm visualization, and more versatile clipping angles. Enhanced exposure results in a potentially higher rate of complete aneurysm obliteration and complication avoidance.

Subtemporal exposure of the intrapetrous internal carotid artery. An Anatomical study with surgical application

1999 ◽  
Vol 113 (8) ◽  
pp. 717-720 ◽  
Author(s):  
Maged B. Naguib ◽  
Mario Sanna
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Internal Auditory Canal ◽  
Anatomical Study ◽  
Bone Drilling ◽  
Subtemporal Approach ◽  
Working Space ◽  
Surgical Application ◽  
Temporal Bones

AbstractThis work describes the exposure of the intrapetrous internal carotid artery (ICA) through the subtemporal approach. The anatomical details of 25 fresh temporal bones were studied and provided the initial background for this procedure. Bone drilling in the meatal plane anterior to the internal auditory canal could create a four-sided quadrangular area. The exposure of the ICA through this area was applied on three occasions. It proved safe as regards the surrounding structures and also provided an ample working space for the extirpation of tumours surrounding the artery.

DIFFICULTIES IN DIAGNOSING MOYA-MOYA DISEASE (CLINICAL CASE)

2020 ◽  
pp. 48-53
Author(s):  
Novikova I.N. ◽  
Popova T.F. ◽  
Gribacheva I.A. ◽  
Petrova E.V. ◽  
Marushchak A.A. ◽  
...  
Keyword(s):  
Cerebral Angiography ◽  
Neurological Disorders ◽  
Clinical Case ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Moya Moya Disease ◽  
Middle Cerebral Arteries ◽  
Internal Carotid Arteries ◽  
Made In

Moya-Moya disease is a rare progressive chronic cer-ebrovascular disease characterized by a narrowing of the lumen of the intracranial segments of the internal carotid arteries, as well as the initial segments of the anterior and middle cerebral arteries with the devel-opment of a network of small vascular anastomoses. Violations of blood supply due to occlusion lead to the development of ischemic strokes in the correspond-ing pools, and ruptures of vascular anastomoses - to the development of hemorrhagic strokes, causing a variety of neurological disorders. The article presents a clinical case of Moya-Moya disease in a 31-year-old patient. The disease was manifested by acute disorders of cerebral circulation in ischemic and hemorrhagic types. The diagnosis was made in accordance with the diagnostic criteria of the disease based on the data of endovascular cerebral angiography.

Retinal macroaneurysm after carotid endarterectomy in patient with chronic ischemic retinopathy associated with hemodynamically significant stenosis of the internal carotid artery (clinical case)

2021 ◽  
pp. 274-277
Author(s):  
V.V. Tuzlaev ◽  
◽  
O.V. Kolenko ◽  
V.V. Egorov ◽  
I.Z. Kravchenko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Clinical Case ◽  
Internal Carotid ◽  
Significant Stenosis ◽  
Ischemic Retinopathy ◽  
Retinal Macroaneurysm ◽  
Intraretinal Hemorrhages

Purpose. To present a clinical case of development of retinal macroaneurysm after carotid endarterectomy (CE) in patient with chronic ischemic retinopathy (CIR) associated with hemodynamically significant stenosis of the internal carotid artery (ICA). Material and methods. Patient R., 74 years old, diagnosed with CIR of the 1st degree of severity of the right eye. In addition to standard ophthalmic examination methods, Doppler ultrasound with registration of blood flow in the orbital artery and spiral computed tomography of the ICA were performed. Results. Panretinal photocoagulation (PRP) of the retina led to obliteration of the retinal macroaneurysm, resorption of intraretinal hemorrhages, and stabilization of the course of CIR after CE of the ICA. Conclusion. The appearance of retinal macroaneurysm and intraretinal hemorrhages after CE in patient with CIR associated with hemodynamically significant ICA stenosis can be regarded as reperfusion complications after restoration of blood flow in the orbital artery, which requires timely retinal PRP of the retina. Key words: chronic ischemic retinopathy, retinal macroaneurysm, internal carotid artery, carotid endarterectomy.

Sleep across childhood during the COVID-19 pandemic: a narrative review of the literature and clinical case examples

2021 ◽  
pp. 1-23
Author(s):  
Melanie A. Stearns ◽  
Carolyn E. Ievers-Landis ◽  
Christina S. McCrae ◽  
Stacey L. Simon
Keyword(s):  
Clinical Case ◽  
Narrative Review ◽  
Review Of The Literature ◽  
Case Examples

scholarly journals Surgical considerations about the anterior syphon knee of the internal carotid artery

1995 ◽  
Vol 53 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Murilo S. Meneses ◽  
Danielle Molinari ◽  
Marcia Fortes ◽  
Patricia Rangel ◽  
Tatiana Neves ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Vascular Lesions ◽  
Intracavernous Carotid Artery ◽  
Microsurgical Approach ◽  
Microsurgical Techniques ◽  
Anatomical Finding ◽  
Anterior Knee

An anatomical study about the anterior knee of the intracavernous carotid artery is presented. Twenty cavernous sinuses (CS) were dissected in cadavers using microsurgical techniques. A fibrous ring around the internal carotid artery (ICA) at the CS roof was found in all specimens. This fibrous attachment could be dissected from the surrounding dura and a loose connective tissue could be demonstrated around the ICA. This anatomical finding makes possible the microsurgical approach to vascular lesions of this portion of the ICA, without opening the cavernous sinus.

Clinical Case Examples

2018 ◽  
pp. 45-49
Author(s):  
Nicole A. Sciarrino ◽  
Tyler Elizabeth Hernandez ◽  
Jennifer Davidtz
Keyword(s):  
Clinical Case ◽  
Case Examples

The Unified Protocol for Eating Disorders

2017 ◽  
pp. 150-163
Author(s):  
Christina L. Boisseau ◽  
James F. Boswell
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Emotional Disorders ◽  
Clinical Case ◽  
Case Examples ◽  
Transdiagnostic Treatment ◽  
Unified Protocol ◽  
Outpatient Settings

This chapter describes the application of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, and other specified feeding or eating disorders. We focus on the five core treatment modules, highlighting aspects of each one that are particularly relevant to eating disorders and discuss the evidence supporting their use. Next, using clinical case examples from both residential and outpatient settings, we illustrate how each of these core modules can be applied to the treatment of eating disorders. Finally, we provide recommendations for future applications of the UP in this population.

Laser

2010 ◽  
pp. 568-585
Author(s):  
Peter O’Kane ◽  
Simon Redwood
Keyword(s):  
Balloon Angioplasty ◽  
Clinical Case ◽  
Laser Energy ◽  
Medical Application ◽  
Laser Angioplasty ◽  
Case Examples ◽  
Tissue Interactions ◽  
Percutaneous Coronary ◽  
Catheter Technology ◽  
Carbon Dioxide Co2

The first medical application of laser was reported by Dr Leon Goldman who, in 1962, reported the use of ruby and carbon dioxide (CO2) lasers in dermatology. In cardiovascular disease, early laser use was confined to cadaver vessels, animal models, and arteries located in freshly amputated limbs, until eventually work progressed to the use of laser energy to salvage an ischaemic limb in 1984. The concept of using laser to remove atherosclerotic material in coronary arteries developed as an alternative strategy to simply modifying the shape of an obstructed lumen as occurs with simple balloon angioplasty. Expectations grew that this new biomedical technology may overcome the low success rate and high complication rate of lesions considered non-ideal for balloon angioplasty. However, initial successful reports could not be replicated. Furthermore, underdeveloped catheter technology and limited appreciation of laser/tissue interactions meant that a cure for restenosis was not in fact discovered and laser coronary angioplasty became isolated to only a few centres in the world. However, more recently with advancement in both catheter technology and technique, excimer coronary laser angioplasty (ELCA) has been rediscovered for use in specific subsets of percutaneous coronary interventions (PCIs). This chapter outlines the basic principles of ELCA and important practical aspects for using the device in contemporary PCI. A discussion of the current indications for clinical use follows and these are highlighted by clinical case examples.

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