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.

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.

scholarly journals Evaluation of Surgical Clipping and Endovascular Coiling on Oculomotor Nerve Palsy Caused by Internal Carotid Artery Aneurysm

2020 ◽  
Vol 11 ◽  
Author(s):  
Zhenqing Sun ◽  
Xueqiang Yan ◽  
Xiaolong Li ◽  
Jie Wu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Recovery Rate ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping

Objectives: Internal carotid artery (ICA) aneurysm often leads to oculomotor nerve palsy (ONP) that impairs eye movement. Currently, microsurgical clipping and endovascular coiling are the two major options to treat ONP. The purpose of the current study is to compare the clinical outcomes of the two methods in patients with ONP caused by ICA aneurysm.Patients and Methods: In the present study, we assessed the prognostic factors and recovery outcomes of a total of 90 ICA aneurysm-induced ONP patients, where 50 of them were treated with microsurgical clipping and 40 of them were treated with endovascular coiling. Within the endovascular coiling group, 20 of the patients were treated with balloon-assisted coiling and the other 20 were treated with stent-assisted coiling.Results: Overall, we achieved a 59% (53 out of 90) full recovery rate. Both surgical clipping and endovascular coiling treatment methods achieved similar recovery outcomes in the tested patients. However, within the endovascular coiling group, balloon-assisted coiling treatment demonstrated a significantly higher full recovery rate (17 out of 20) compared to stent-assisted coiling treatment (eight out of 20).Conclusion: In general, no significant difference was identified between the surgical and coiling treatments, and both procedures were considered as beneficial for ICA aneurysm-induced ONP.

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).

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.

scholarly journals Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

2017 ◽  
Vol 23 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Jeremy J Heit ◽  
Nicholas A Telischak ◽  
Huy M Do ◽  
Robert L Dodd ◽  
Gary K Steinberg ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Morbidity ◽  
Case Description ◽  
Digital Subtraction ◽  
Pipeline Embolization Device ◽  
Aneurysm Occlusion ◽  
New Treatment

Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.

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