Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome

Matano, Fumihiro; Tanikawa, Rokuya; Kamiyama, Hiroyasu; Ota, Nakao; Tsuboi, Toshiyuki; Noda, Kosumo; Maeda, Shiro; Matsukawa, Hidetoshi; Murai, Yasuo; Morita, Akio

doi:10.1016/j.wneu.2015.08.068

Cited by 32 publications

(15 citation statements)

References 30 publications

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“…Although favorable outcomes have been reported for surgical treatment of OphA aneurysms in this and previous studies, 2,10,20,21,23,27 advances in endovascular techniques and technology have increased the popularity of endovascular therapy for paraclinoid aneurysms. 8,10,11,29,31 However, endovascular treatment is associated with a lower rate of complete aneurysm occlusion and more frequent recurrences that might lead to hemorrhage or necessitate retreatment.…”

Section: Endovascular Therapy For Opha Aneurysmsmentioning

confidence: 60%

“…Thus, direct surgery for paraclinoid aneurysms remains an indispensable option. 21 Previous studies demonstrate that microsurgery offers definitive and durable treatment for paraclinoid aneurysms with an acceptable complication rate, 2,10,12,20,21,23,27 but recent studies document a concerning rate of new visual deficits. 15,18,19,22,24,25 In addition, the frequency of aneurysm remnants is higher in this region due to limitations in visualizing pathology on the medial wall of the ICA through the narrow corridor of the optic-carotid triangle.…”

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confidence: 99%

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Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Kamide

Tabani

Safaee

et al. 2018

Journal of Neurosurgery

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OBJECTIVE While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms. METHODS Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed. RESULTS Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits. CONCLUSIONS The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.

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Section: Endovascular Therapy For Opha Aneurysmsmentioning

confidence: 60%

mentioning

confidence: 99%

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Kamide

Tabani

Safaee

et al. 2018

Journal of Neurosurgery

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“…Initially reported as an intradural procedure, the resection of the ACP has also been described as an extradural resection, intradural resection, hybrid extra/intradural resection, fracture removal, drilling removal, and ultrasonic. Although each has its advantages and disadvantages, there is still no consensus on the best method to safely remove the ACP and avoid CSF rhinorrhea 8,9,10,11,12,13,14,15,16,17 . Further, there is even less literature on how to proceed when this worrisome complication does occur.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management

Beer‐Furlan¹,

Balsalobre²,

Vellutini³

et al. 2016

Arq. Neuro-Psiquiatr.

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Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.

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“…Matano et al . [ 28 ] reported 127 cases of paraclinoid aneurysm surgery, among which delayed visual disturbance was observed in 8 cases and the cause was hypothesized to be gradual compression of the ophthalmic nerves by a small hematoma, vasospasm of the superior hypophyseal artery, or bankruptcy microcirculation due to opening of the dural ring or optic canal.…”

Section: Discussionmentioning

confidence: 99%

Radical resection of a craniopharyngioma via the extradural anterior temporal approach with zygomatic arch osteotomy

Ota¹,

Tanikawa²,

Miyama³

et al. 2016

Surg Neurol Int

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Background:Though the extradural anterior temporal approach (EDATA) with zygomatic osteotomy is useful, there are only few reports of this approach being used for craniopharyngioma resection. Herein, we report our surgical case series and the technical importance of EDATA for the radical removal of a craniopharyngioma.Methods:We report 7 cases of craniopharyngiomas treated surgically between April 1999 and October 2015. The surgical approaches, clinical presentation, pre and postoperative radiographic examination results, surgical outcomes, and morbidity were analyzed.Results:The mean follow-up period was 89.1 months. The surgical approach was EDATA with zygomatic osteotomy in 4, combined interhemispheric translamina terminalis approach (IHTLA) and trans-sylvian anterior temporal approach (ATA) in 2, and IHTLA in 1 patient. Complete tumor resection was achieved in all cases, without any recurrence during the follow-up period. Transient morbidities were oculomotor nerve palsy in 2, and meningitis and hydrocephalus in 1 patient. There was 1 case of permanent morbidity due to hydrocephalus that needed a ventriculoperitoneal shunt, and 1 case of blindness on the operative side. Visual acuity and visual field improved in 4 cases, showed no change in 2 cases, and deteriorated in 1 case. Though the pituitary stalk was preserved in 2 cases, all 7 cases needed total hormone replacement therapy.Conclusion:EDATA with zygomatic osteotomy ensures sufficient mobility of the internal carotid artery, and provides a good lateral and look up operative view. Hence, it can be used effectively for radical resection of craniopharyngiomas through the opticocarotid space and retrocarotid space.

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Surgical Treatment of 127 Paraclinoid Aneurysms with Multifarious Strategy: Factors Related with Outcome

Cited by 32 publications

References 30 publications

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms

Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management

Radical resection of a craniopharyngioma via the extradural anterior temporal approach with zygomatic arch osteotomy

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