Quantitative Anatomic Study of the Transciliary Supraorbital Approach

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons205-ons210 ◽  
Author(s):  
Daniel D. Cavalcanti ◽  
Ulises García-González ◽  
Abhishek Agrawal ◽  
Neil R. Crawford ◽  
Paulo Leonardo M. S. Tavares ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Image Guidance ◽  
Internal Carotid ◽  
Anatomic Study ◽  
Vertical Angle ◽  
Anterior Circulation ◽  
Supraorbital Approach ◽  
Before And After ◽  
Orbital Rim ◽  
Anterior Circulation Aneurysms

Abstract BACKGROUND The transciliary supraorbital approach (TCSO) provides an anterior view for visualizing sellar, parasellar, and suprasellar structures. Whether an orbital osteotomy adds to this exposure has not been quantified. OBJECTIVE We quantitatively evaluated the TCSO and benefits of an additional orbital osteotomy for exposing common sites of anterior circulation aneurysms. METHODS Under image guidance, TCSO and orbital osteotomy were performed on 10 sides of 5 cadaver heads to quantify exposures of 4 surgical targets: (1) the junction of the anterior cerebral and anterior communicating arteries (ACoA); (2) the internal carotid artery (ICA) at the level of the posterior communicating artery (PCoA); (3) the bifurcation of the ICA; and (4) the middle cerebral artery (MCA) bifurcation. Horizontal and vertical angles of attack and surgical freedom for instrument manipulation were measured before and after the orbital rim and roof were removed. RESULTS An orbital osteotomy significantly increased surgical freedom to the ACoA (from 471.15 ± 182.14 mm2 to 683.35 ± 283.78 mm2, P = .021); PCoA (from 746.58 ± 242.78 mm2 to 966.23 ± 360.22 mm2, P = .007); ICA bifurcation (from 616.08 ± 310.95 mm2 to 922.38 ± 374.88 mm2, P = .002); and MCA bifurcation (from 1160.77 ± 412.03 mm2 to 1597.71 ± 733.18 mm2, P = .004). There were no significant differences in horizontal angles of attack. The vertical angles of attack were significantly greater after orbital osteotomy, principally with the ACoA and ICA bifurcation as targets. CONCLUSION TCSO combined with orbital osteotomy improves exposure. Removing the orbital rim and roof increases the area for instrument use and improves the vertical angle of attack to common sites in the anterior circulation involving aneurysms.

The Minipterional Craniotomy for Anterior Circulation Aneurysms: Initial Experience With 72 Patients

2014 ◽  
Vol 10 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Justin M. Caplan ◽  
Kyriakos Papadimitriou ◽  
Wuyang Yang ◽  
Geoffrey P. Colby ◽  
Alexander L. Coon ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Temporalis Muscle ◽  
Anterior Circulation ◽  
Pterional Craniotomy ◽  
Anterior Circulation Aneurysms

Abstract BACKGROUND: The pterional craniotomy is well established for microsurgical clipping of most anterior circulation aneurysms. The incision and temporalis muscle dissection impacts postoperative recovery and cosmetic outcomes. The minipterional (MPT) craniotomy offers similar microsurgical corridors, with a substantially shorter incision, less muscle dissection, and a smaller craniotomy flap. OBJECTIVE: To report our experience with the MPT craniotomy in select unruptured anterior circulation aneurysms. METHODS: From January 2009 to July 2013, 82 unruptured aneurysms were treated in 72 patients, with 74 MPT craniotomies. Seven patients had multiple aneurysms treated with a single MPT craniotomy. The average patient age was 56 years (range: 24-87). Aneurysms were located along the middle cerebral artery (n = 36), posterior communicating (n = 22), paraophthalmic (n = 22), choroidal (n = 1), and dorsal ICA segments (n = 1). The MPT craniotomy utilized an incision just posterior to the hairline and a single myocutaneous flap. RESULTS: The average aneurysm size was 5.45 mm (range: 1-14). There were no instances of compromised operative corridors requiring craniotomy extension. Three significant early postoperative complications included epidural and subdural hematomas requiring evacuation, and a middle cerebral artery infarction. Average length of hospitalization was 3.96 days (range: 2-20). Two patients required reoperation for wound infections. Average follow-up was 421 days (range: 5-1618). Minimal to no temporalis muscle wasting was noted in 96% of patients. CONCLUSION: The MPT craniotomy is a worthwhile alternative to the standard pterional craniotomy. There were no instances of suboptimal operative corridors and clip applications when the MPT craniotomy was utilized in the treatment of unruptured middle cerebral artery and supraclinoid internal carotid artery aneurysms proximal to the terminal internal carotid artery bifurcation.

Anterior circulation aneurysms: anatomy and surgical techniques

2010 ◽  
pp. 573-580
Author(s):  
George Samandouras
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Surgical Techniques ◽  
Anterior Circulation ◽  
Middle Cerebral Artery Aneurysms ◽  
Anterior Circulation Aneurysms

Chapter 9.9 covers the anatomy and surgical techniques of anterior circulation aneurysms, internal carotid artery (ICA) aneurysms, anterior cerebral artery aneurysms, and middle cerebral artery aneurysms.

scholarly journals Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex: analysis of a single-institution series of 568 cases

2018 ◽  
Vol 129 (6) ◽  
pp. 1475-1481 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Matthew T. Bender ◽  
Li-Mei Lin ◽  
Narlin Beaty ◽  
Justin M. Caplan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Flow Diversion ◽  
Single Institution ◽  
Anterior Circulation ◽  
Major Complications ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications.METHODSA prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015.RESULTSA total of 568 PED procedures (252 classic and 316 Flex) were performed for anterior circulation aneurysms. The average aneurysm size was 6.8 mm. Patients undergoing treatment with the Flex device had smaller aneurysms (p = 0.006) and were more likely to have undergone previous treatments (p = 0.001). Most aneurysms originated along the internal carotid artery (89% classic and 75% Flex) but there were more anterior cerebral artery (18%) and middle cerebral artery (7%) deployments with Flex (p = 0.001). Procedural success was achieved in 96% of classic and 98% of Flex cases (p = 0.078). Major morbidity or death occurred in 3.5% of cases overall: 5.6% of classic cases, and 1.9% of Flex cases (p = 0.019). On multivariate logistic regression, predictors of major complications were in situ thrombosis (OR 4.3, p = 0.006), classic as opposed to Flex device (OR 3.7, p = 0.008), and device deployment in the anterior cerebral artery or middle cerebral artery as opposed to the internal carotid artery (OR 3.5, p = 0.034).CONCLUSIONSFlow diversion of anterior circulation cerebral aneurysms is associated with an overall low rate of major complications. The complication rate is significantly lower since the introduction of the second-generation PED (Flex).

scholarly journals Extradural minipterional approach for giant intracranial aneurysms

2020 ◽  
Vol 11 ◽  
pp. 382
Author(s):  
Rafael Martinez-Perez ◽  
Asterios Tsimpas ◽  
Holger Joswig ◽  
Victor Hernandez-Alvarez ◽  
Jorge Mura
Keyword(s):  
Carotid Artery ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Anterior Clinoidectomy ◽  
Aneurysm Occlusion ◽  
Third Cranial Nerve Palsy ◽  
Key Steps ◽  
Anterior Circulation Aneurysms

Background: The clinical applicability of the minipterional (MPT) craniotomy is still limited to small and superficial anterior circulation aneurysms. We discuss the technical nuances of a modified MPT approach, the extradural MPT approach (eMPTa), for the treatment of a giant intracranial aneurysm (GIA) arising from the paraclinoid carotid artery. Case Description: A 44-year-old female presented with facial hypoesthesia and third cranial nerve palsy. Further investigations revealed the presence of a 27 mm aneurysm arising from the communicating segment of the internal carotid artery. The patient underwent surgical clipping through an extradural MPT craniotomy and combined anterior clinoidectomy. Postoperative angio-computed tomography demonstrated complete aneurysm occlusion and patency of the parent vessels. The patient recovered fully from her previous deficits. Conclusion: The skull base drilling, interdural dissection, and anterior clinoidectomy are key steps during the eMPTa that optimizes the use of the extradural corridor. Such adaptations are enough to improve the surgical maneuverability along the paraclinoid region and adapt the MPT suitability for the treatment of complex GIA.

Bony Dehiscence of the Horizontal Petrous Internal Carotid Artery Canal: An Anatomic Study with Surgical Implications

2018 ◽  
Vol 114 ◽  
pp. e1174-e1179 ◽  
Author(s):  
Alexander Spiessberger ◽  
Fabian Baumann ◽  
Karl Friedrich Kothbauer ◽  
Mohammed Aref ◽  
Serge Marbacher ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomic Study

scholarly journals Possibility of Middle Meningeal Artery-to-Petrous Internal Carotid Artery Bypass: An Anatomic Study

Skull Base ◽  
2004 ◽  
Vol 14 (3) ◽  
pp. 153-156 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Mustafa Büyükmumcu ◽  
Muzaffer Şeker ◽  
Ahmet Kağan Karabulut ◽  
İsmihan İlknur Uysal ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Middle Meningeal Artery ◽  
Anatomic Study ◽  
Meningeal Artery

Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Abhi Pandhi ◽  
Yasser M Khorchid ◽  
Abhishek Ojha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Efficacy And Safety ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Cervical Internal Carotid Artery

Introduction: Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion Methods: We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion. Results: A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement. Discussion: Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.

scholarly journals Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2558-2562
Author(s):  
Jai Ho Choi ◽  
Jinhee Jang ◽  
Jaseong Koo ◽  
Kook-Jin Ahn ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Diagnostic Value ◽  
Fisher Exact Test ◽  
Anterior Circulation

Background and Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value. Methods: Thirty patients with nonvisualization of the proximal ICA were included. Diagnosis of pseudo- or true occlusion of the ICA was made based on digital subtraction angiography. Diagnostic performances of multiphasic computed tomography angiography findings—(1) a flame-shaped stump and (2) delayed contrast filling at the cervical ICA— were evaluated and compared. The Fisher exact test, χ 2 test, or Wilcoxon rank-sum test and McNemar test were used in the data analysis. Results: Twelve patients had true proximal ICA occlusion and 18 had pseudo-occlusion. Delayed contrast filling at the cervical ICA on multiphasic computed tomography angiography was found in all patients with pseudo-occlusion of the ICA, while 1 case of true occlusion showed delayed contrast filling ( P <0.001). The presence of a flame-shaped stump was not significantly different between the pseudo- and true occlusion groups. The sensitivity of delayed contrast filling (0.94 [95% CI, 0.73–1]) was significantly higher than that of flame-shaped stump (0.75 [95% CI, 0.36–0.83]). Conclusions: We demonstrated that the delayed filling sign on multiphasic computed tomography angiography could be a useful and readily available finding for differentiating proximal ICA pseudo-occlusion from true occlusion.

Sign in / Sign up

Export Citation Format

Share Document