Postoperative Anosmia after Anterior Communicating Artery Aneurysms Surgery by the Pterional Approach

Aydin, İsmail Hakkı; Kadıoğlu, Hakan Hadi; Tüzün, Yusuf; Kayaoğlu, Çetin Refik; Takçı, Erhan; Öztürk, Mesut

doi:10.1055/s-2008-1052220

Cited by 32 publications

(39 citation statements)

References 3 publications

(8 reference statements)

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“…Plus, arachnoid dissection and mobilization of the olfactory nerve can release it from retraction. 1,3 The current study has several important limitations. First, it was based on a retrospective review of a small case series from a single institution.…”

Section: Discussionmentioning

confidence: 92%

“…Based on results from previous studies of ruptured aneurysms, surgical clipping via a pterional approach and ACoA aneurysms are already known to present an increased risk to olfaction. 1,3,13,16 Aydin et al 1 revealed that 15% of patients with an ACoA aneurysm developed unilateral or bilateral olfactory dysfunction. Additionally, in a previous Sniffin' Sticks test, 14% of patients with a ruptured ACoA aneurysm had abnormal binostril olfaction after a pterional approach.…”

Section: Discussionmentioning

confidence: 99%

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Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Park

Son²,

Goh³

et al. 2016

JNS

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A pterionAl approach and its modifications are commonly used for clipping most anterior circulation aneurysms. In such an approach, the frontal lobe and olfactory nerve are both retracted to some degree to access aneurysms located in the circle of Willis. In particular, in cases of an anterior communicating artery (ACoA) aneurysm, a retractor is placed across the olfactory tract, which is damaged primarily by retractor pressure and strain. Thus, olfactory dysfunction following a pterional approach occurs most frequently in cases of ACoA aneuaBBreViatiONS ACoA = anterior communicating artery; AUC = area under the ROC curve; CTA = CT angiography; DSA = digital subtraction angiography; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage. OBJectiVe The highest incidence of olfactory dysfunction following a pterional approach and its modifications for an intracranial aneurysm has been reported in cases of anterior communicating artery (ACoA) aneurysms. The radiological characteristics of unruptured ACoA aneurysms affecting the extent of retraction of the frontal lobe and olfactory nerve were investigated as risk factors for postoperative olfactory dysfunction. methOdS A total of 102 patients who underwent a pterional or superciliary keyhole approach to clip an unruptured ACoA aneurysm from 2006 to 2013 were included in this study. Those patients who complained of permanent olfactory dysfunction after their aneurysm surgery, during a postoperative office visit or a telephone interview, were invited to undergo an olfactory test, the Korean version of the Sniffin' Sticks test. In addition, the angiographic characteristics of ACoA aneurysms, including the maximum diameter, the projecting direction of the aneurysm, and the height of the neck of the aneurysm, were all recorded based on digital subtraction angiography and sagittal brain images reconstructed using CT angiography. Furthermore, the extent of the brain retraction was estimated based on the height of the ACoA aneurysm neck. reSultS Eleven patients (10.8%) exhibited objective olfactory dysfunction in the Sniffin' Sticks test, among whom 9 were anosmic and 2 were hyposmic. Univariate and multivariate analyses revealed that the direction of the ACoA aneurysm, ACoA aneurysm neck height, and estimated extent of brain retraction were statistically significant risk factors for postoperative olfactory dysfunction. Based on a receiver operating characteristic (ROC) analysis, an ACoA aneurysm neck height > 9 mm and estimated brain retraction > 12 mm were chosen as the optimal cutoff values for differentiating anosmic/hyposmic from normosmic patients. The values for the area under the ROC curves were 0.939 and 0.961, respectively. cONcluSiONS In cases of unruptured ACoA aneurysm surgery, the height of the aneurysm neck and the estimated extent of brain retraction were both found to be powerful predictors of the occurrence of postoperative olfactory dysfunction.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Park

Son²,

Goh³

et al. 2016

JNS

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“…It must be point out that, the exact location of the Sylvian fissure medially is not always apparent and that the fissure does not always "open" in a clean arachnoidal plane, as is frequently illustrated [1][2][3][4][5][6][7][8][9][10][11]. It is possible to see the variations of the width of the Sylvian cistern and the middle cerebral artery position in some cases [1].…”

Section: Sylvian Dissectionmentioning

confidence: 99%

“…I got this Yasargil's approach named as "Yasargil Surgical Highway". Today, most neurosurgeons use one of these two basic surgical approaches, although with some minor modifications and refinements [1][2][3][4][5][6][7][8][9][10][11]. The pterional approach is commonly employed in surgery of the anterior circulation and upper basilar artery aneurysms, as well as for the tumors of orbital.…”

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confidence: 99%

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Yasargil Higway in Neurosurgery (For the nineteen years old of my teacher Mahmut Gazi YASARGIL)

Aydin¹

2014

JNSK

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My Teacher Professor Yasargil is very famous doctor, mentor, surgeon, lider, scientist, researcher, inventor and teacher of last Century, not only in Neurosurgery, but also in Neuroscience of the World. His very important Neurosurgical Way and thecniques, the pterional trans Sylvian approach, I called as "Yasargil Higway" is commonly employed in surgery of the anterior circulation and upper basilar artery aneurysms, as well as for the tumors of orbital, retroorbital, sellar, chiasmatic, sub frontal and prepontine areas and lesions around the sella especially for lesions behind the clivus. Also tumors arising from the medial sphenoid ridge, the superior orbital fissure, the anteromedial temporal surface, or the cavernous sinus region are approached through a pterional exposure.The modification of surgical technique is based on the experience, training and observation of the neurosurgeon. One technique is not necessarily better than the another. Regardless of the surgical technique, the end results depend on a rigorous, methodical, systematic, and step by-step approach to the target, securing it with minimal injury to surrounding structures.In this article, according to the personal experiences of Ismail Hakkı Aydin, MD (the Author), it was analyzed the Intraoperative anatomical findings of the Sylvian vein and fissure, lenticulostriatal artery, olfactory nerve, and recurrent artery of Heubnerand showed the surgical pitfalls and steps in personal cases with different diagnoses that were operated on with the pterional approach in Yasargil Higway. All patients were operated on by the Author. The findings were recorded during surgical interventions and through the slides and videotapes of the operations. Also, we have stressed the preservation of the front temporal branch of the facial nerve, the delicate retraction of frontal lobe, the cottonoid retraction in temporal lobe and the preservation of olfactory nerve functions. Keywords IntroductionAccording to our article data that was published in 1995 [1], all steps of Pterional Yasargil Higway approach reevaluated and gold advices reviewed step by step in this paper. Different surgical methods have so far been reported for accesses to parasellar and sellar areas [1][2][3][4][5][6][7][8][9][10]. The sub temporal approach was first described by Drake in 1961 [11]. Yasargil introduced the frontotemporosphenoidal craniotomy, which was named as a pterional approach in 1969. I got this Yasargil's approach named as "Yasargil Surgical Highway". Today, most neurosurgeons use one of these two basic surgical approaches, although with some minor modifications and refinements [1][2][3][4][5][6][7][8][9][10][11]. The pterional approach is commonly employed in surgery of the anterior circulation and upper basilar artery aneurysms, as well as for the tumors of orbital. Retro orbital, sellar, chiasmatic, sub frontal, and prepontine areas and lesions around the sell a. especially for lesions behind the clivus. Also tumors arising from the medial sphenoid ridge, the superior o...

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Anatomy of the olfactory nerve: A comprehensive review with cadaveric dissection

López-Elizalde

Campero²,

Sánchez-Delgadillo

et al. 2017

Clinical Anatomy

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Because of their anatomical situation, the olfactory nerves constitute a natural obstacle to exploring the anterior cranial fossa, making them vulnerable to traumatic, tumor, or iatrogenic lesions. Consequently, accurate knowledge of their microsurgical anatomy is of particular importance for surgeons to ensure the correct execution of surgical procedures with minimal sequelae, the least functional deterioration, and better therapeutic results. This review describes the functional and microsurgical anatomy of the olfactory nerves, illustrated with pictures of simulations based on cadaveric dissections and original illustrations of the central connections of the olfactory pathway. Clin. Anat. 31:109-117,

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Postoperative Anosmia after Anterior Communicating Artery Aneurysms Surgery by the Pterional Approach

Cited by 32 publications

References 3 publications

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Yasargil Higway in Neurosurgery (For the nineteen years old of my teacher Mahmut Gazi YASARGIL)

Anatomy of the olfactory nerve: A comprehensive review with cadaveric dissection

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