Two Cases of Superior Hypophyseal Artery Aneurysm Clipped Through Contralateral Pterional Approach.

✓ During surgery undertaken for a symptomatic middle cerebral artery (MCA) aneurysm, an asymptomatic carotid-ophthalmic artery aneurysm on the contralateral side was inadvertently ruptured. The carotid-ophthalmic aneurysm was clipped successfully via the contralateral pterional approach. The MCA aneurysm was also clipped at the same time.

Download Full-text

Contralateral Pterional Approach to a Giant Internal Carotid-Ophthalmic Artery Aneurysm: Technical Case Report

Neurosurgery ◽

10.1097/00006123-200104000-00059 ◽

2001 ◽

Vol 48 (4) ◽

pp. 955-959 ◽

Cited By ~ 3

Author(s):

Kazuhiro Hongo ◽

Nobuaki Watanabe ◽

Naoko Matsushima ◽

Shigeaki Kobayashi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ophthalmic Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Giant Aneurysm ◽

Pterional Approach ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Contralateral Pterional Approach

Abstract OBJECTIVE AND IMPORTANCE The contralateral approach to internal carotid-ophthalmic artery aneurysms has been used in selected cases but has rarely been described for a giant internal carotid artery aneurysm. We report a case of giant aneurysm that was successfully clipped via the contralateral pterional approach. CLINICAL PRESENTATION A 69-year-old woman was found to have two aneurysms: a small aneurysm at the left internal carotid-posterior communicating artery and a giant aneurysm at the right internal carotid-ophthalmic artery. INTERVENTION A direct clipping operation was performed via the left pterional approach. After the small left internal carotid artery aneurysm was clipped, the contralateral giant aneurysm was further exposed and successfully clipped by use of the same approach via the prechiasmatic space. CONCLUSION The contralateral pterional approach can be applied even for a giant aneurysm of the carotid-ophthalmic artery aneurysm when the neck of the aneurysm is small and when there is a space between the anterior wall of the aneurysm and the tuberculum sellae. Furthermore, such a giant aneurysm can be clipped more easily and safely via the contralateral approach without compromising visual functions. To our knowledge, this is the first reported case of a giant internal carotid-ophthalmic artery aneurysm approached contralaterally. The feasibility of this approach can be assessed preoperatively by three-dimensional computed tomographic angiography as well as by conventional cerebral angiography.

Download Full-text

Basilar Superior Cerebellar Artery Aneurysm Treated with Clipping via a Contralateral Pterional Approach

Surgery for Cerebral Stroke ◽

10.2335/scs.47.381 ◽

2019 ◽

Vol 47 (5) ◽

pp. 381-384

Author(s):

Nobusuke TSUZUKI ◽

Hiroshi KAGEYAMA ◽

Shingo YAMASHITA ◽

Terushige TOYOOKA

Keyword(s):

Artery Aneurysm ◽

Superior Cerebellar Artery ◽

Pterional Approach ◽

Cerebellar Artery ◽

Contralateral Pterional Approach

Download Full-text

OLFACTORY DYSFUNCTION AFTER IPSILATERAL AND CONTRALATERAL PTERIONAL APPROACHES FOR CEREBRAL ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000350225.36099.0b ◽

2009 ◽

Vol 65 (4) ◽

pp. 727-732 ◽

Cited By ~ 28

Author(s):

Jaechan Park ◽

Sun-Ho Lee ◽

Dong-Hun Kang ◽

Jung-Soo Kim

Keyword(s):

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Olfactory Dysfunction ◽

Anterior Communicating Artery ◽

Pterional Approach ◽

Anterior Circulation ◽

Related Risk ◽

Lateral Distance ◽

Contralateral Pterional Approach ◽

Anterior Circulation Aneurysms

Abstract OBJECTIVE This study investigated olfactory dysfunction after using a contralateral or ipsilateral pterional approach for anterior circulation aneurysms and related risk factors. METHODS This study included 189 patients who experienced an aneurysmal subarachnoid hemorrhage and in whom a pterional approach was used, including a contralateral pterional approach (12 patients), a pterional approach for an anterior communicating artery (AComA) aneurysm (70 patients), and an ipsilateral pterional approach for aneurysms of the anterior circulation, excluding the AComA (107 patients). In addition to questionnaires on olfactory function, Sniffin' Sticks tests were performed 12 to 38 months after the operation. RESULTS The incidence of olfactory dysfunction was high: 58% (7 of 12) with a contralateral pterional approach, 14% (10 of 70) with a pterional approach for an AComA aneurysm, and 4% (4 of 107) with an ipsilateral pterional approach for aneurysms of the anterior circulation, except for the AComA. In addition, patients 55 years and older had a higher incidence of olfactory dysfunction. Among the 12 patients in whom the contralateral pterional approach was used, 5 (42%) were anosmic and 2 (17%) were hyposmic. The incidence of olfactory dysfunction was also significantly higher at ages 55 years and older. The size and location of the contralateral aneurysm, if small (<1 cm) and located within a 3-cm lateral distance from the midline, were not found to influence the incidence. CONCLUSION A higher incidence of olfactory dysfunction was found in those patients in whom a contralateral pterional approach and a pterional approach for an AComA aneurysm were used. Another major risk factor was an age of 55 years and older.

Download Full-text

The surgical approach for clipping anterior communicating artery Aneurysm

Nepal Journal of Neuroscience ◽

10.3126/njn.v16i1.24424 ◽

2019 ◽

Vol 16 (1) ◽

pp. 10-20

Author(s):

Robin Bhattarai ◽

Chuan Chen ◽

Chao Feng Liang ◽

Teng Chao Huang ◽

Hui Wang ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Intracranial Aneurysms ◽

Artery Aneurysm ◽

Anterior Communicating Artery ◽

Aneurysm Surgery ◽

Pterional Approach ◽

Supraorbital Approach ◽

Lateral Supraorbital Approach ◽

Eyebrow Incision ◽

Frontal Branch

Anterior communicating artery (ACoA) aneurysm, accounts for 30%-35% of all the aneurysm making it one of the most common intracranial aneurysms. Although the Pterional approach is considered as the safe and appropriate method in ACoA aneurysm surgery, temporalis atrophy and injury to a frontal branch of the facial nerve are few inexorable complications. With the advancement of minimally invasive surgery several modified approaches, such as the supraorbital eyebrow incision approach, the minipterional approach, the mini-supraorbital approach, and the lateral supraorbital approach has been recently introduced and has been used as an alternative.

Download Full-text

Parameters for Contralateral Approach to Ophthalmic Segment Aneurysms of the Internal Carotid Artery

Neurosurgery ◽

10.1097/00006123-200011000-00022 ◽

2000 ◽

Vol 47 (5) ◽

pp. 1130-1137 ◽

Cited By ~ 45

Author(s):

Yukinari Kakizawa ◽

Yuichiro Tanaka ◽

Yasser Orz ◽

Tomomi Iwashita ◽

Kazuhiro Hongo ◽

...

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Bone Resection ◽

Pterional Approach ◽

Aneurysm Neck ◽

Contralateral Approach ◽

Ophthalmic Segment Aneurysms ◽

Contralateral Pterional Approach

Abstract OBJECTIVE This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA). METHODS Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram. RESULTS Parameters A to F were 8.8 mm (range, 5.4–11.1 mm), 14.5 mm (range, 10.4–22.2 mm), 0.9 mm (range, 0.6–1.3 mm), and 3.0 mm (range, 2.3–4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3–2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm. CONCLUSION Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.

Download Full-text

Anterior communicating artery aneurysm clipping using standard small fronto-pterional approach, clipping with 3 Lazic clips

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14541 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video6 ◽

Cited By ~ 1

Author(s):

Michael Reinert ◽

Luca Valci ◽

Martina Dalolio ◽

Vladimir Reyes ◽

Justine D'Auria

Keyword(s):

Surgical Treatment ◽

Neurological Deficit ◽

Artery Aneurysm ◽

Gait Disturbance ◽

Anterior Communicating Artery ◽

Pterional Approach ◽

Aneurysm Clipping ◽

Anterior Communicating Artery Aneurysm ◽

Icg Angiography ◽

Temporary Clipping

An 80-year-old female presented 5 months previous for nonspecific gait disturbance, during which an MRI was performed. A large based anterior communicating artery aneurym was found independent of neurology. An interdisciplinary discussion favored surgical treatment, on which the patient insisted.Surgery was performed using standard anesthesia techniques with intraoperative burst supression during surgery, neuromonitoring with MEP and SEP, as well as ICG angiography, microdoppler and neuronavigation. Successful clipping was performed with 2 fenestrated straight and one bayoneted straight Lazic clip. Temporary clipping was 6.1 minutes. Postoperative angiography showed exclusion of the aneurysm, and there was no neurological deficit.The video can be found here: http://youtu.be/WKjOHG8irFo.

Download Full-text