Selective extradural anterior clinoidectomy for supra- and parasellar processes

1997 ◽  
Vol 87 (4) ◽  
pp. 636-642 ◽  
Author(s):  
Yasuhiro Yonekawa ◽  
Nobuyoshi Ogata ◽  
Hans-Georg Imhof ◽  
Magnus Olivecrona ◽  
Kevin Strommer ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Basilar Artery ◽  
Artery Aneurysm ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Anterior Clinoidectomy ◽  
Basilar Artery Aneurysm ◽  
Sphenoid Ridge ◽  
Fine Print

✓ Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction. Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningiomas). The ACP was removed extradurally in 31 cases and intradurally in nine cases. Extradural clinoidectomy was performed in all cases of pituitary adenoma and craniopharyngioma and in most cases of basilar artery aneurysm. Intradural clinoidectomy was performed in two cases of ICA—ophthalmic artery aneurysm, two cases of ICA—posterior communicating artery aneurysm, two cases of ICA cavernous aneurysm, one case of basilar artery aneurysm, and two cases of sphenoid ridge meningioma. The outcome was satisfactory in all patients, except for one patient who underwent clipping of a basilar tip aneurysm and suffered a thalamic and midbrain infarction. Three patients who underwent extradural clinoidectomy suffered a postoperative diminution of visual acuity or a visual field defect on the side of the clinoidectomy. These deficits may have been caused either by drilling of the ACP or by other operative manipulation of the optic nerve. Cerebrospinal fluid rhinorrhea, which required reoperation, occurred in one patient. The authors' experience suggests that the extradural technique of ACP removal is easier and less time consuming than the intradural one and provides better operative exposure. It can be used routinely in treating lesions in the supra- and parasellar regions.

Selective extradural anterior clinoidectomy for supra- and parasellar processes

1997 ◽  
Vol 3 (2) ◽  
pp. E2 ◽  
Author(s):  
Yasuhiro Yonekawa ◽  
Nobuyoshi Ogata ◽  
Hans-Georg Imhof ◽  
Magnus Olivecrona ◽  
Kevin Strommer ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Basilar Artery ◽  
Pituitary Tumors ◽  
Artery Aneurysm ◽  
Anterior Clinoid Process ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Anterior Clinoidectomy ◽  
Basilar Artery Aneurysm ◽  
Brain Retraction ◽  
Sphenoid Ridge

Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction. Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningiomas). The ACP was removed extradurally in 31 cases and intradurally in nine cases. Extradural clinoidectomy was performed in all cases of pituitary adenoma and craniopharyngioma and in most cases of basilar artery aneurysm. Intradural clinoidectomy was performed in two cases of ICA-ophthalmic artery aneurysm, two cases of ICA-posterior communicating artery aneurysm, two cases of ICA cavernous aneurysm, one case of basilar artery aneurysm, and two cases of sphenoid ridge meningioma. The outcome was satisfactory in all patients, except for one patient who underwent clipping of a basilar tip aneurysm and suffered a thalamic and midbrain infarction. Three patients who underwent extradural clinoidectomy suffered a postoperative diminution of visual acuity or a visual field defect on the side of the clinoidectomy. These deficits may have been caused either by drilling of the ACP or by other operative manipulation of the optic nerve. Cerebrospinal fluid rhinorrhea, which required reoperation, occurred in one patient. The authors' experience suggests that the extradural technique of ACP removal is easier and less time consuming than the intradural one and provides better operative exposure. It can be used routinely in treating lesions in the supra- and parasellar regions.

Cerebral aspergillosis

1973 ◽  
Vol 38 (4) ◽  
pp. 472-476 ◽  
Author(s):  
Pongsakdi Visudhiphan ◽  
Sira Bunyaratavej ◽  
Suwarindr Khantanaphar
Keyword(s):  
Brain Abscess ◽  
Intracranial Hemorrhage ◽  
Basilar Artery ◽  
Artery Aneurysm ◽  
Diagnosis And Treatment ◽  
Content Type ◽  
Basilar Artery Aneurysm ◽  
Fine Print

✓ Three patients with cerebral aspergillosis are reported. Each patient had a different lesion: a solitary brain abscess, a mycotic basilar artery aneurysm, and a massive infective intracranial hemorrhage. Aspergillosis is discussed, including its diagnosis and treatment.

A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia

1971 ◽  
Vol 35 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Peter Davidson ◽  
David M. Robertson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Artery Aneurysm ◽  
Content Type ◽  
Intracranial Involvement ◽  
Basilar Artery Aneurysm ◽  
Fine Print

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.

Extradural anterior clinoidectomy

2005 ◽  
Vol 102 (5) ◽  
pp. 945-950 ◽  
Author(s):  
Akio Noguchi ◽  
Vijayabalan Balasingam ◽  
Yoshiaki Shiokawa ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Anatomical Variations ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Anterior Clinoidectomy ◽  
Small Structure ◽  
Surgical Field ◽  
The Brain ◽  
Fine Print

✓ The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions—either tumors or aneurysms—in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subsequent derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

Total removal of large global meningiomas at the medial aspect of the sphenoid ridge

1971 ◽  
Vol 34 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Albert W. Cook
Keyword(s):  
Optic Nerve ◽  
Middle Cerebral Artery ◽  
Operative Technique ◽  
Middle Meningeal Artery ◽  
Medial Aspect ◽  
Total Removal ◽  
Content Type ◽  
Meningeal Artery ◽  
Sphenoid Ridge ◽  
Fine Print

✓ An operative technique for total removal of large global meningiomas at the medial aspect of the sphenoid ridge is described, and experience with 11 patients reported. The technique involves extradural liberation of the dural and tumor attachments to the underlying bone, and extradural occlusion of the blood supply through bone and middle meningeal artery. Subsequent procedures are carried out sequentially in the parasellar area to free the optic nerve and carotid, in the subtemporal tentorial region to release tumor from neighboring structures, and in the Sylvian fissure to isolate the middle cerebral artery.

Splitting of the optic nerve by a carotid-ophthalmic artery aneurysm

1986 ◽  
Vol 65 (4) ◽  
pp. 560-562 ◽  
Author(s):  
Robert A. Beatty
Keyword(s):  
Optic Nerve ◽  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A patient with splitting of the optic nerve by a carotid-ophthalmic artery aneurysm is presented. Possible explanations for this previously unreported configuration are discussed.

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases

1991 ◽  
Vol 75 (5) ◽  
pp. 694-701 ◽  
Author(s):  
Jonathan E. Hodes ◽  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Daniel Rüfenacht ◽  
Siegfried Bien ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Content Type ◽  
Fine Print

✓ Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the pre-embolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Adenosine-induced transient asystole for management of a basilar artery aneurysm

1999 ◽  
Vol 91 (4) ◽  
pp. 687-690 ◽  
Author(s):  
Michael W. Groff ◽  
David C. Adams ◽  
Ronald A. Kahn ◽  
Uday M. Kumbar ◽  
Bo-Yi Yang ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Circulatory Arrest ◽  
Artery Aneurysm ◽  
Deep Hypothermic Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Basilar Artery Aneurysm ◽  
Profound Hypotension ◽  
Definition Of ◽  
Temporary Clipping

✓ Advances in anesthetic and surgical management, such as induced deep hypothermic circulatory arrest and application of temporary clips, have improved outcome for patients with basilar artery aneurysms. Nonetheless, these techniques are associated with significant risks. The authors report a case in which three transient periods of cardiac asystole were induced during basilar artery aneurysm surgery. Adenosine-induced asystole facilitated the safe clipping of the aneurysm by producing consistent periods of profound hypotension and collapse of the aneurysm without the need for temporary clipping. This technique provided unencumbered identification of perforating arteries, precise definition of the local anatomy, and an ideal environment for the safe placement of the aneurysm clip.

Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region

1994 ◽  
Vol 81 (2) ◽  
pp. 230-235 ◽  
Author(s):  
J. Diaz Day ◽  
Steven L. Giannotta ◽  
Takanori Fukushima
Keyword(s):  
Basilar Artery ◽  
Cranial Nerve ◽  
Pathological Process ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Surgical Access ◽  
Complete Obliteration ◽  
Brain Retraction ◽  
Fine Print

✓ Surgical access to the parasellar, infrachiasmatic, and posterior clinoid regions has traditionally been accomplished through an intradural pterional or subtemporal approach. However, for large or complex lesions in these locations, such traditional trajectories may not afford sufficient exposure for complete obliteration of the pathological process. The authors describe an anterolateral transcavernous approach to this region that includes the following components: 1) extradural removal of the sphenoid wing and exposure of the superior orbital fissure and foramen rotundum; 2) removal of the anterior clinoid process via the anterolateral route; 3) decompression of the optic canal; 4) extradural retraction of the temporal tip; 5) transcavernous mobilization of the carotid artery and third cranial nerve; and 6) removal of the posterior clinoid process. This method results in enhanced exposure with minimal brain retraction and preservation of the temporal tip bridging veins. This approach has been used in 22 patients: 10 with basilar top aneurysms, eight with craniopharyngiomas, one with a tuberculum sellae meningioma, and two with trigeminal neuromas; the last patient had a carotidcavernous fistula and a concomitant pituitary adenoma. Complete clip ligation was performed for all 10 basilar artery aneurysms, and gross total resection was achieved with preservation of the pituitary stalk in all tumor cases. Microscopic total resection was not possible in two cases of craniopharyngioma due to hypothalamic invasion. Two patients suffered transient postoperative hemiparesis, and one patient has persisting weakness; however, no patient followed for more than 6 months suffered any persistent cranial nerve morbidity. It is concluded that this procedure can serve as an alternative to either the transsylvian or subtemporal approaches when cranial base pathologies are large or complex.

Mobilization of the internal carotid artery for basilar artery aneurysm surgery

1997 ◽  
Vol 86 (2) ◽  
pp. 294-296 ◽  
Author(s):  
Takeshi Matsuyama ◽  
Takahide Shimomura ◽  
Yoshinari Okumura ◽  
Toshisuke Sakaki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Optic Canal ◽  
Aneurysm Surgery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Orbital Roof

✓ The authors describe a technique for mobilization of the internal carotid artery (ICA) for basilar artery (BA) aneurysm surgery. Using the epidural approach, the anterior clinoid process, orbital roof, and optic canal are drilled away. The ICA is made mobile to the C3 segment by cutting the dural ring and dissecting the ICA from the carotid groove. The ophthalmic artery is then dissected from the optic canal. This mobilization of the ICA secures wide operative fields on both its medial and lateral sides and permits complete clipping of BA aneurysms.

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