Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome

Jesús, Orlando De; Sekhar, Laligam N.; Riedel, Charles J.

doi:10.1016/s0090-3019(98)00137-2

Cited by 126 publications

(89 citation statements)

References 28 publications

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“…It is continuous with the roof of the cavernous sinus along its lateral aspect, overlying the superior surface of the anterior clinoid process, and is also continuous with the diaphragma sellae along its posteromedial aspect and the dura mater covering the tuberculum sellae along its anteromedial aspect 2,11,13,22) . Clinically, it is critical to discriminate between aneurysms proximal to the dural ring and aneurysms distal to the dural ring, because their locations determine surgical indications and the patient's prognosis 4,7,11,18) . If an unruptured proximal carotid aneurysm can be demonstrated with certainty to lie below the dural ring, the risk of subsequent SAH is extremely low, since the aneurysm is protected by the overlying anterior clinoid process and dural reflection 1,14) .…”

Section: Discussionmentioning

confidence: 99%

“…The natural history of aneurysms involving the paraclinoid area varies based on their anatomic locations and hence the precise localization by neuroimaging study in preoperative period has been one of the most interesting and important problems in clinical neurosurgery 4,7,11,18,24,25) . Aneurysms identified as being completely intradural are at risk for subarachnoid hemorrhage (SAH), and usually require preventive endovascular or surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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Distinction between Intradural and Extradural Aneurysms Involving the Paraclinoid Internal Carotid Artery with T2-Weighted Three-Dimensional Fast Spin-Echo Magnetic Resonance Imaging

Lee

Jung

Huh

et al. 2010

J Korean Neurosurg Soc

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Objective : The precise intra-vs. extradural localization of aneurysms involving the paraclinoid internal carotid artery is critical for the evaluation of patients being considered for aneurysm surgery. The purpose of this study was to investigate the clinical usefulness of T2-weighted threedimensional (3-D) fast spin-echo (FSE) magnetic resonance (MR) imaging in the evaluation of unruptured paraclinoid aneurysms. Methods : Twenty-eight patients with unruptured cerebral aneurysms in their paraclinoid regions were prospectively evaluated using a T2-weighted 3-D FSE MR imaging technique with oblique coronal sections. The MR images were assessed for the location of the cerebral aneurysm in relation to the dural ring and other surrounding anatomic compartments, and were also compared with the surgical or angiographic findings. Results : All 28 aneurysms were identified by T2-weighted 3D FSE MR imaging, which showed the precise anatomic relationships in regards to the subarachnoid space and the surrounding anatomic structures. Consequently, 13 aneurysms were determined to be intradural and the other 15 were deemed extradural as they were confined to the cavernous sinus. Of the 13 aneurysms with intradural locations, three superior hypophyseal artery aneurysms were found to be situated intradurally upon operation. Conclusion : High-resolution T2-weighted 3-D FSE MR imaging is capable of confirming whether a cerebral aneurysm at the paraclinoid region is intradural or extradural, because of the MR imaging's high spatial resolution. The images may help in identifying patients with intradural aneurysms who require treatment, and they also can provide valuable information in the treatment plan for paraclinoid aneurysms. KEY WORDS :Dural ring˙ Internal carotid artery˙ Magnetic resonance imaging˙ Paraclinoid aneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distinction between Intradural and Extradural Aneurysms Involving the Paraclinoid Internal Carotid Artery with T2-Weighted Three-Dimensional Fast Spin-Echo Magnetic Resonance Imaging

Lee

Jung

Huh

et al. 2010

J Korean Neurosurg Soc

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“…11 We then performed postprocessing of dynamic angiographic data, including volume rendering, using the Integris workstation (Philips Medical Systems). The orientation of the aneurysmal neck and sac was determined according to the angiographic classification described by De Jesus et al 2 as follows: we distinguished medial or lateral projections on the anterior view and anterior or posterior projections on the lateral view.…”

Section: Angiographic Technique and Classificationmentioning

confidence: 99%

“…[1][2][3][4][5] The main goal of the treatment is to prevent subarachnoid hemorrhage (SAH) from aneurysmal rupture, which is associated to high rates of morbidity and mortality. 6 Asymptomatic extradural (intracavernous) aneurysms are at lower risk of subarachnoid hemorrhage than transitional or intradural aneurysms (1.4% of SAH and exceptional cataclysmic epistaxis).…”

mentioning

confidence: 99%

Usefulness of MR Imaging for the Assessment of Nonophthalmic Paraclinoid Aneurysms

Thines¹,

Gauvrit²,

Leclerc³

et al. 2007

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The neuroradiologic location of asymptomatic paraclinoid aneurysms is decisive for patient management. In a preliminary study, we designed a paraclinoid MR protocol (PMP) including high-resolution T2-weighted images in 2 orthogonal planes to define the inferior limit of the distal dural ring plane that represents the borderline between the intradural and extradural internal carotid artery. In this clinical study, we compared this protocol with digital subtraction angiography (DSA) for the location of paraclinoid aneurysms.

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“…The distal dural ring (DDR) is the anatomical boundary between the intra-and extradural segments of the internal carotid artery (ICA) in the paraclinoid region. 2,9,19,24 Some studies tried to delineate the DDR with imaging methods and differentiate the aneurysm in the vicinity of the anterior clinoid process (ACP). 5,16,23 However, these studies either lacked direct surgical confirmation or comprised a small case number.…”

mentioning

confidence: 99%

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

Liao

Lin²,

Lin

et al. 2016

JNS

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T he treatment of paraclinoid aneurysms remains challenging. 7,8,10,17,18,25 It is important to differentiate the exact location of the paraclinoid aneurysm, whether intradural or not, when considering treatment options. The distal dural ring (DDR) is the anatomical boundary between the intra-and extradural segments of the internal carotid artery (ICA) in the paraclinoid region. 2,9,19,24 Some studies tried to delineate the DDR with imaging methods and differentiate the aneurysm in the vicinity of the anterior clinoid process (ACP). 5,16,23 However, these studies either lacked direct surgical confirmation or comprised a small case number.aBBreViatiONS ACP = anterior clinoid process; C 4 = cavernous segment; C 5 = clinoid segment; C 6 = ophthalmic segment; CTA = CT angiography; DDR = distal dural ring; DSA = digital subtraction angiography; ICA = internal carotid artery; OphA = ophthalmic artery; OS = optic strut; PDR = proximal dural ring; ROC = receiver operating characteristic; TS = tuberculum sellae. OBJectiVe The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). methOdS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. reSultS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional ane...

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Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome

Cited by 126 publications

References 28 publications

Distinction between Intradural and Extradural Aneurysms Involving the Paraclinoid Internal Carotid Artery with T2-Weighted Three-Dimensional Fast Spin-Echo Magnetic Resonance Imaging

Distinction between Intradural and Extradural Aneurysms Involving the Paraclinoid Internal Carotid Artery with T2-Weighted Three-Dimensional Fast Spin-Echo Magnetic Resonance Imaging

Usefulness of MR Imaging for the Assessment of Nonophthalmic Paraclinoid Aneurysms

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

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