scholarly journals Penetration of the Optic Nerve and Falciform Ligament by an Internal Carotid Artery-Ophthalmic Artery Aneurysm

2014 ◽  
Vol 54 (3) ◽  
pp. 211-213 ◽  
Author(s):  
Yasushi TAKAGI ◽  
Susumu MIYAMOTO
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Falciform Ligament

Penetration of the Optic Nerve by an Internal Carotid Artery-Ophthalmic Artery Aneurysm: Case Report and Literature Review

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 996-1000 ◽  
Author(s):  
Andrew Jea ◽  
Mustafa K. Başkaya ◽  
Jacques J. Morcos
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
World Literature ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Nerve Fibers ◽  
Visual Deterioration ◽  
Operative Exploration

Abstract OBJECTIVE AND IMPORTANCE Although it is well known that large or giant internal carotid artery-ophthalmic artery aneurysms can cause visual deficits, penetration and schism of the optic nerve by an aneurysm are very rare. CLINICAL PRESENTATION A 48-year-old man presented with an acute onset of right visual deterioration after an episode of severe headache. Magnetic resonance imaging demonstrated penetration of the right optic nerve by an intracranial aneurysm. Cerebral angiography revealed an internal carotid artery-ophthalmic artery aneurysm of 12 × 7 mm. The aneurysm was directed superomedially and appeared to have a “waist” within the penetration. INTERVENTION Intraoperatively, we observed that part of the aneurysm wall was visible through the optic nerve fibers at the junction with the optic chiasm. CONCLUSION Although there was no direct evidence of subarachnoid hemorrhage on imaging scans or with operative exploration, we think that the patient must have experienced sentinel hemorrhaging, leading to visual deterioration. We describe the case in detail and review the world literature.

scholarly journals Accessing the Medial Surface of the Paraclinoid Internal Carotid Artery via the Contralateral Interoptic Trajectory: An Anatomical Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiaochun Zhao ◽  
Ali Tayebi-Meybodi ◽  
Mohamed Labib ◽  
Evgenii Belykh ◽  
Leandro Borba Moreira ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Sagittal Plane ◽  
Vertical Line ◽  
Coronal Plane ◽  
Falciform Ligament ◽  
Medial Surface ◽  
Accessible Area

Abstract INTRODUCTION Aneurysms arising on the medial surface of the paraclinoid segment of the internal carotid artery (ICA) are surgically challenging. Using the space between bilateral optic nerves, the contralateral interoptic (CIO) trajectory can partially expose the medial paraclinoid ICA. In this study, we quantitatively measured the accessible area of the medial ICA through the CIO trajectory and offered a potential patient selection algorism based on the preoperative angiogram. METHODS The CIO trajectory was performed on 10 sides of cadaveric heads, through which the paraclinoid ICA was identified. The falciform ligament medial to the contralateral optic nerve was incised to avoid injuring the contralateral optic nerve. The contralateral optic nerve was gently elevated and the medial surface of the paraclinoid ICA was inspected via different angles to obtain the maximal exposure. The accessible area was painted with a dye, the distance from the distal dural ring (DDR) to the proximal and distal boarders of this accessible area was measured. The superior and inferior borders were measured using the clockface method relative to a vertical line on the coronal plane. RESULTS The average distances from DDR to the proximal and distal end of the accessible area are [Mean ± SD] 2.7 ± 1.65 and 8.8 ± 2.35 mm, respectively. On the coronal plane, the average angles of the superior and inferior end of the accessible area relative to a vertical line are 24.3 ± 16.50° and 129.3 ± 15.40°, respectively. CONCLUSION Through a CIO trajectory, the paraclinoid ICA can be exposed 2.7 8.8 mm distal to the DDR on the sagittal plane and 24.3 16.5° medially on the coronal plane. Aneurysms with necks falling within this range can be accessed via a CIO trajectory, which can offer a reference of preoperative parameters for patients' selection.

Treatment of Carotid Ophthalmic Aneurysm With Woven EndoBridge (WEB SL): 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E424-E425 ◽  
Author(s):  
Matthew J Recker ◽  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal H Dossani ◽  
Elad I Levy
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Minor Trauma ◽  
Woven Endobridge ◽  
Web Device

Abstract Wide-necked cerebral aneurysms often require complex treatment strategies for optimal treatment. As the surgeon's arsenal continues to expand, consideration of all potential applications of available devices is important. The Woven EndoBridge (WEB) device (MicroVention-Terumo, Aliso Viejo, California) capitalizes on flow disruption to promote thrombosis and is Food and Drug Administration (FDA) approved for saccular wide-necked bifurcation aneurysms located at the middle cerebral artery bifurcation, internal carotid artery (ICA) terminus, anterior communicating artery complex, and basilar apex. In this video, we demonstrate an off-label use of the WEB to treat a wide-necked type II1 ophthalmic artery aneurysm, highlighting the importance of correct device sizing. The patient is a 74-yr-old woman with a family history of aneurysms. Her aneurysm was found incidentally after a minor trauma. Observation and various treatment options were considered. The patient preferred to avoid open surgical intervention and dual antiplatelet therapy. Endoluminal flow diversion for types II and III ophthalmic artery aneurysms has relatively low occlusion rates and a higher incidence of visual field deficits.1 A WEB device can be an excellent alternative to treat these aneurysms. A biaxial system was used to selectively catheterize the supraclinoid internal carotid artery and then the aneurysm, and optimal flow diversion was achieved. The patient did well and was discharged home the next day on aspirin alone. Six-month angiography showed near-occlusion of the aneurysm and ophthalmic artery patency. The neck remnant will be followed up with repeat angiography in 6 mo. The patient gave informed consent for the procedure and video recording. Institutional review board approval was deemed unnecessary. Video ©University at Buffalo Neurosurgery, 2019. With permission.

scholarly journals Modified One-Piece Extended Transbasal Approach for Endoscopic-Assisted Microsurgical Resection of Tuberculum Sellae Meningioma: Operative Video and Technical Nuances

2017 ◽  
Vol 79 (S 02) ◽  
pp. S213-S214 ◽  
Author(s):  
James Liu ◽  
Kentaro Watanabe
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Falciform Ligament ◽  
Tuberculum Sellae Meningioma ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Microsurgical Resection ◽  
Tuberculum Sellae

AbstractThe optimal approach for surgical resection of tuberculum sellae meningiomas remains controversial. Approach selection is largely based on a variety of factors, such as tumor size, extent and location relative to the optic canal and internal carotid artery, the presence of vascular encasement, and surgeon's preference. In this operative video manuscript, the authors demonstrate the importance of an open transcranial approach when the tumor extends lateral to the optic nerve over the internal carotid artery into the opticocarotid triangle, which is a difficult region to safely access with a purely endoscopic endonasal approach. We present a case of an endoscopic-assisted microsurgical resection of a tuberculum sellae meningioma using a modified one-piece extended transbasal approach in a patient with unilateral visual loss. The approach allows both interhemispheric and subfrontal routes to the suprasellar region. Early optic nerve decompression and division of the falciform ligament is critical to optimize visual outcomes. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, optic nerve decompression, tumor-arachnoid dissection, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient had restoration of normal vision with normal pituitary function. In summary, the modified one-piece extended transbasal approach with endoscopic assistance is an important strategy in the armamentarium for surgical management of tuberculum sellae meningiomas.The link to the video can be found at: https://www.youtube.com/watch?v=jKNtRzMSFVE.

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