Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process

2002 ◽  
Vol 96 (4) ◽  
pp. 788-791 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Katsuya Futawatari ◽  
Kazuo Mizoi ◽  
Naoki Higashiyama ◽  
Hisashi Kojima ◽  
...  
Keyword(s):  
Visual Field ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Operating Microscope ◽  
Aneurysm Surgery ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Endoscopic Guidance ◽  
Posterior Communicating Artery Aneurysm ◽  
Fine Print

✓ A 47-year-old man presented with a superior hypophyseal artery aneurysm and an ipsilateral posterior communicating artery aneurysm. Both lesions were successfully clipped without removal of the anterior clinoid process or retraction of the optic nerve by using endoscopic guidance. The endoscope was introduced into the prechiasmatic cistern and provided a clear visual field around the aneurysm that could not be seen via the operating microscope. The endoscope was useful in the identification of the medially projecting lesion and the small perforating branches of the ophthalmic segment of the internal carotid artery. A fenestrated clip could be introduced around the neck of the aneurysm and placed in the best position under endoscopic guidance. Endoscopy-assisted clipping is potentially a very useful procedure for aneurysm surgery.

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.

Pupillary sparing in oculomotor palsy from internal carotid aneurysm

1975 ◽  
Vol 42 (6) ◽  
pp. 713-717 ◽  
Author(s):  
Ira Kasoff ◽  
David L. Kelly
Keyword(s):  
Internal Carotid ◽  
Artery Aneurysm ◽  
Oculomotor Palsy ◽  
Content Type ◽  
The Third ◽  
Subarachnoid Bleeding ◽  
Posterior Communicating Artery Aneurysm ◽  
Anatomic Relationship ◽  
Third Nerve ◽  
Fine Print

✓ The authors report a patient with a carotid-posterior communicating artery aneurysm; although the oculomotor palsy accompanying such an aneurysm is almost universally recognized as being complete, with pupillary involvement, this patient had pupillary sparing in the absence of subarachnoid bleeding. A few similar cases have appeared in the literature. The mechanism of pupillary sparing appears to be based on the position of the parasympathetic pupilloconstrictor fibers within the subarachnoid portion of the third nerve and on the anatomic relationship between the third nerve and the junction of the carotid and posterior communicating arteries.

Automobile accidents caused by unsuspected neurological disease

1973 ◽  
Vol 38 (5) ◽  
pp. 581-583 ◽  
Author(s):  
James R. Keane
Keyword(s):  
Neurological Disease ◽  
Neurological Diseases ◽  
Artery Aneurysm ◽  
The Other ◽  
Automobile Accidents ◽  
Content Type ◽  
Cerebral Trauma ◽  
Left Posterior ◽  
Posterior Communicating Artery Aneurysm ◽  
Fine Print

✓ Two patients admitted as cerebral trauma cases following single-car automobile accidents were found to have previously-unsuspected, surgically-treatable neurological diseases that undoubtedly caused the accidents. A left posterior communicating artery aneurysm was clipped in one patient and a right frontal lobe abscess aspirated in the other, with excellent results in both patients.

Carotid cave aneurysms of the internal carotid artery

1989 ◽  
Vol 70 (2) ◽  
pp. 216-221 ◽  
Author(s):  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Hirohiko Gibo ◽  
Sathyaranjandas A. Hegde ◽  
Toshiki Takemae ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Blade Ring ◽  
Curved Blade ◽  
Anteroposterior View

✓ In a series of 32 surgical cases of carotid-ophthalmic artery aneurysm, seven of the lesions were located in the “carotid cave.” This special type of aneurysm is usually small and projects medially on the anteroposterior view of the angiogram. At surgery, it is located intradurally at the dural penetration of the internal carotid artery (ICA) on the ventromedial side, appears to be buried in the dural pouch (carotid cave), and is often difficult to find, dissect, and clip. The aneurysm extends into the cavernous sinus space, and the parent ICA penetrates the dural ring obliquely. An ipsilateral pterional approach was used in all 32 cases, and ring clips were used exclusively because the aneurysms were located ventromedially. Clipping was successful in five cases. All patients returned to their preoperative occupation, although vision worsened postoperatively in two cases. The technical steps required for successful obliteration of this aneurysm are summarized as follows: 1) exposure of the cervical ICA; 2) unroofing of the optic canal and removal of the anterior clinoid process; 3) exploration of the ICA around the dural ring and opening of the cavernous sinus; 4) direct retraction of the ICA and optic nerve; and 5) application of multiple ring clips to conform to the natural curvature of the carotid artery; a curved-blade ring clip is especially useful. The relevant topographic anatomy is discussed.

Foreign-body granuloma as a complication of wrapping and coating an intracranial aneurysm

1990 ◽  
Vol 72 (2) ◽  
pp. 292-294 ◽  
Author(s):  
Toshihiko Haisa ◽  
Korehito Matsumiya ◽  
Norio Yoshimasu ◽  
Nobuo Kuribayashi
Keyword(s):  
Foreign Body ◽  
Rare Case ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Foreign Body Granuloma ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Aron Alpha ◽  
Fine Print

✓ A rare case is presented in which a foreign-body granuloma developed at the site of muslin wrapping and Aron Alpha A coating of an internal carotid artery aneurysm. The importance of avoiding the use of muslin, especially close to the optic nerve and chiasm, is emphasized.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

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.

The minor leak preceding subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Richard Leblanc
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Computerized Tomography ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
A Minor ◽  
Fine Print

✓ Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive. A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.

Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms

2004 ◽  
Vol 101 (6) ◽  
pp. 989-995 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Toshiharu Yanagisawa ◽  
Akira Suzuki ◽  
Tohru Ohta ◽  
Yoshitaka Hirano ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Bone Structure ◽  
Surgical Complication ◽  
Artery Aneurysm ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Perforating Arteries ◽  
Fine Print

Object. The authors of this study evaluated the efficacy of simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery (ICA) aneurysms. Methods. The endoscopic technique was applied during microsurgery in 11 patients with 13 aneurysms. Nine of these lesions were located on the posterior communicating artery (PCoA), three in the paraclinoid region, and one on the anterior choroidal artery (AChA). Eight patients had unruptured aneurysms and three had ruptured aneurysms. The endoscope was introduced after first exposing the aneurysm through the microscope and was gripped firmly by an air-locked holding arm fitted with a steering system throughout the entire surgery, including dissection of the perforating arteries and application of the aneurysm clips. Regarding paraclinoid aneurysms, clips were applied through direct visualization of the ophthalmic artery and the proximal neck. In a case involving a superior hypophyseal artery aneurysm in the paraclinoid segment, a ring clip was applied without removing the bone structure around the optic canal. In all aneurysms of the PCoA and the AChA, perforating arteries behind the lesion were identified and dissected using endoscopic control. The aneurysm clip was applied in the best position in a single attempt in 10 of 11 patients. There was no surgical complication related to the endoscopic procedures. Conclusions. Simultaneous monitoring with the microscope and endoscope is extremely useful in applying clips to ICA aneurysms. This combined method allows for direct dissection of the aneurysm, perforating vessels, and the main trunk in an area not visible through the microscope's eyepiece and promises better surgical results.

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