A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms

Serrano, Lucas; Ayyad, Ali; Archavlis, Eleftherios; Schwandt, Eike; Nimer, Amr; Ringel, Florian; Kantelhardt, Sven R.

doi:10.1007/s10143-018-01063-3

Cited by 12 publications

(8 citation statements)

References 47 publications

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“…The versatility of the pterional approach is such that it can be used even for aneurysms of the contralateral side, as demonstrated by many authors (46)(47)(48)(49)(50), and also confirmed by the reported illustrative case. Our long-lasting experience in the surgical management of intracranial aneurysms allowed us to identify some variables at the basis of the tailoring of the pterional approach route to the basilar tip, the so-called "half-and-half approach" (57,58).…”

Section: Tailoring the Pterional Approachsupporting

confidence: 67%

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

et al. 2022

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INTRODUCTION Most of the versatility of the pterional approach depends on a series of variations progressively reported by several groups, but little emphasized over the years. The present study condenses the technical notes which the authors adopted in their practice to maximize the surgical freedom of the pterional approach, at once lessening the approach-related complication rate. METHODS Data of a series of patients who underwent a pterional approach between January 2011 and May 2021 were retrospectively reviewed focusing on the technical variations compared to the original Yaşargil’s description. The anatomical rationale, technique, and advantages were outlined and validated through the appraisal of functional and cosmetic complications. RESULTS 994 patients were reviewed. Head extension was avoided in the case of anterior clinoidectomy. A single double-layered galea-pericranium flap was used for duraplasty. The submuscular technique, with compulsive preservation of deep temporal fascia and deep temporal arteries, was preferred for temporalis muscle dissection. McCarty keyhole was never used, thus avoiding exposing the orbit if unnecessary. Widening of the superior orbital fissure and thinning of the orbital roof allowed to significantly increase the working area. The average follow-up was 7.2 years. The overall rate of functional and cosmetic complications was 2.1. DISCUSSION In the authors' experience, the gradual adoption of technical variations related to the patient's positioning, soft tissue dissection, bony work, dura opening, and reconstruction allowed to enhance the versatility of the pterional approach concurrently decreasing the risk of functional and cosmetic complications.

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Section: Tailoring the Pterional Approachsupporting

confidence: 67%

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

et al. 2022

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“…4 A standard pterional craniotomy was used, as in most published case series. 2,8,9 During the intracranial dissection, the sylvian fissure was fully split to maximize the frontal lobe elevation, and the carotid cistern was entered by sharply opening the arachnoid membrane around the optic nerve and carotid artery. A subfrontal approach was established after subsequent arachnoid dissection between the basal frontal lobe and the optic nerves.…”

Section: Surgical Approachmentioning

confidence: 99%

“…1). 1,2 Despite these challenges, this approach can be straightforward and effective with appropriate patient selection (i.e., patients with small aneurysms that point medially and superiorly) since this approach offers direct access to the aneurysm without anterior clinoidectomy. 2 In addition, in patients with multiple aneurysms in whom the more formidable aneurysm is lo-cated on the side opposite the paraclinoid aneurysm, the best management may be ipsilateral clipping of the more difficult-to-treat aneurysm and contralateral clipping of the paraclinoid aneurysm.…”

mentioning

confidence: 99%

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

Zhao¹,

Meybodi²,

Labib³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEAneurysms that arise on the medial surface of the paraclinoid segment of the internal carotid artery (ICA) are surgically challenging. The contralateral interoptic trajectory, which uses the space between the optic nerves, can partially expose the medial surface of the paraclinoid ICA. In this study, the authors quantitatively measure the area of the medial ICA accessible through the interoptic triangle and propose a potential patient-selection algorithm that is based on preoperative measurements on angiographic imaging.METHODSThe contralateral interoptic trajectory was studied on 10 sides of 5 cadaveric heads, through which the medial paraclinoid ICA was identified. The falciform ligament medial to the contralateral optic canal was incised, the contralateral optic nerve was gently elevated, and the medial surface of the paraclinoid ICA was inspected via different viewing angles to obtain maximal exposure. The accessible area on the carotid artery was outlined. The distance from the distal dural ring (DDR) to the proximal and distal borders 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. To validate these parameters, preoperative measurements and intraoperative findings were reviewed in 8 clinical cases.RESULTSIn the sagittal plane, the mean (SD) distances from the DDR to the proximal and distal ends of the accessible area on the paraclinoid ICA were 2.5 (1.52) mm and 8.4 (2.32) mm, respectively. In the coronal plane, the mean (SD) angles of the superior and inferior ends of the accessible area relative to a vertical line were 21.7° (14.84°) and 130.9° (12.75°), respectively. Six (75%) of 8 clinical cases were consistent with the proposed patient-selection algorithm.CONCLUSIONSThe contralateral interoptic approach is a feasible route to access aneurysms that arise from the medial paraclinoid ICA. An aneurysm can be safely clipped via the contralateral interoptic trajectory if 1) both proximal and distal borders of the aneurysm neck are 2.5–8.4 mm distal to the DDR, and 2) at least one border of the aneurysm neck on the coronal clockface is 21.7°–130.9° medial to the vertical line.

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“…In case haemostasis cannot be rapidly obtained, exposure and temporary clipping of the ipsilateral cervical ICA should be considered, and thus prepping of the cervical area is still routinely performed in some centres. [68] Manual compression of the ipsilateral or bilateral common carotids has been recommended by other authors. [83] Although this is often a very distressing scenario, the surgeon must not rush to clip blindly in an effort to stop the haemorrhage.…”

Section: Isolation Of the Lesion With Proximal And Distal Controlmentioning

confidence: 99%

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

et al. 2021

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Intraoperative internal carotid artery (ICA) injury during open skull base surgery is a catastrophic complication. Multiple techniques and management strategies have been reported for endoscopic skull base surgery; however, the literature on managing this complication in open skull base surgery is limited. To perform a systematic review and give an overview of the different techniques described to manage this complication intraoperatively, a systematic review was conducted in PubMed, Ovid Medline, Ovid Embase and Scopus for literature published until July 2021. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. PRISMA guidelines were strictly adhered to. Out of 4492 articles, only 12 articles could be included, reflecting an underreporting of open skull base ICA injuries. Multiple techniques can be used depending on the location and size of the injury as well as the surgeon's experience. Described techniques include the following: a primary repair via a micro-suture or nonpenetrating clips; wrapping or plugging; coating; occlusion of the parent artery with or without a bypass; packing with further endovascular management. A treatment algorithm is proposed.

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A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms

Cited by 12 publications

References 47 publications

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

Pterional Approach: Technical Variations, Functional, and Cosmetic Outcome in a Series of 1000 Patients

Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

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