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.

An approach to a basilar aneurysm above the bifurcation of the internal carotid artery

1983 ◽  
Vol 59 (6) ◽  
pp. 1082-1084 ◽  
Author(s):  
Shigeaki Kobayashi ◽  
Kenichiro Sugita ◽  
Fukuo Nakagawa
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Bifurcation ◽  
Content Type ◽  
Temporal Lobes ◽  
Basilar Artery Aneurysm ◽  
Perforating Arteries ◽  
Fine Print

✓ The authors report a case of a basilar artery aneurysm approached by the transsylvian route; the aneurysm was successfully clipped through the space distal to the carotid bifurcation and between the frontal and temporal lobes. This approach is useful when the internal carotid artery is short, sclerotic, and difficult to mobilize. Special care should be taken when retracting perforating arteries and the posterior communicating artery.

Carotid paraclinoid aneurysms with intradural origin and intracavernous location

1978 ◽  
Vol 48 (4) ◽  
pp. 526-533 ◽  
Author(s):  
Stephen Nutik
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Precise Definition ◽  
Separate Entity ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Planning Treatment ◽  
Definition Of ◽  
Fine Print

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.

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.

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.

Balloon-assisted microvascular clipping of paraclinoid aneurysms

2004 ◽  
Vol 100 (4) ◽  
pp. 713-716 ◽  
Author(s):  
William Thorell ◽  
Peter Rasmussen ◽  
John Perl ◽  
Thomas Masaryk ◽  
Marc Mayberg
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Direct Result ◽  
Parent Vessel ◽  
Content Type ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysms ◽  
Fine Print

✓ Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.

Rupture of cavernous carotid artery aneurysm causing subdural hematoma and death

1988 ◽  
Vol 69 (4) ◽  
pp. 617-619 ◽  
Author(s):  
Jonathan E. Hodes ◽  
William A. Fletcher ◽  
Daniel F. Goodman ◽  
William F. Hoyt
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Subdural Hematoma ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Intracavernous Carotid Artery ◽  
Cavernous Carotid Artery ◽  
Fine Print

✓ Aneurysms of the intracavernous portion of the internal carotid artery may become very large, but they very rarely rupture. A case is described in which rupture of such a lesion resulted in a lethal massive subdural hematoma with transtentorial herniation. This is the second reported case of substantiated intracranial rupture from a wholly intracavernous carotid artery aneurysm.

Congenital anastomosis between the vertebral artery and internal carotid artery in the neck

1979 ◽  
Vol 51 (5) ◽  
pp. 697-699 ◽  
Author(s):  
Dwight Parkinson ◽  
Venkatesha Reddy ◽  
R. T. Ross
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysm ◽  
Fine Print

✓ A rare case of anastomosis between the vertebral artery and the internal carotid artery in the neck of a patient with an anterior communicating artery aneurysm is reported.

Superior hypophyseal artery aneurysm

1991 ◽  
Vol 74 (3) ◽  
pp. 501-503 ◽  
Author(s):  
Wesley Y. Yapor ◽  
Robert M. Crowell
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Operative Approach ◽  
Content Type ◽  
Technical Details ◽  
Angiographic Findings ◽  
Fine Print

✓ Two cases of saccular intracranial aneurysms arising from the superior hypophyseal artery take-off from the internal carotid artery are presented. The angiographic findings and technical details of the operative approach are discussed. Particular attention is focused on the use of fenestrated angled clips.

Enlarged anterior spinal artery as collateral circulation

1974 ◽  
Vol 41 (3) ◽  
pp. 356-359 ◽  
Author(s):  
Jun Karasawa ◽  
Haruhiko Kikuchi ◽  
Seiji Furuse ◽  
Toshisuke Sakaki ◽  
Yasumasa Makita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Collateral Circulation ◽  
Internal Carotid ◽  
Vascular Malformations ◽  
Anterior Spinal Artery ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
Vertebral Arteries ◽  
Fine Print

✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.

Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

2000 ◽  
Vol 92 (3) ◽  
pp. 481-487 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Constantine C. Phatouros ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Percutaneous Angioplasty ◽  
Consistent Finding ◽  
Content Type ◽  
Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

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