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Microsurgical Clipping of Ophthalmic Aneurysms in an Endovascular Era: Sonopet-Assisted Intradural Clinoidectomy and Other Tenets
Video Article
Microsurgical Clipping of Ophthalmic Aneurysms in an Endovascular Era: SonopetAssisted Intradural Clinoidectomy and Other Tenets Gregory Glauser and Omar A. Choudhri
Key words Aneurysm clipping - Cerebrovascular - Clinoidectomy - Multiple aneurysms - Ophthalmic artery aneurysm -
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA To whom correspondence should be addressed: Omar A. Choudhri, M.D. [E-mail: [email protected]] Supplementary digital content available online. Citation: World Neurosurg. (2019) 126:398. https://doi.org/10.1016/j.wneu.2019.03.097 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
These video cases present some unique technical tenets for microsurgical clipping of proximal internal carotid artery aneurysms (Video 1). The first patient is a 49-year-old woman with a history of a prior ruptured and treated right middle cerebral artery aneurysm who was found to have growth of known left middle cerebral artery and left internal carotid artery ophthalmic segment aneurysms on radiographic studies. An intradural clinoidectomy with Sonopet, with proximal control at cervical carotid and wide sylvian fissure exposure with ample sharp dissection of the aneurysm anatomy, allowed safe clipping of the ophthalmic aneurysm in this case. The second patient is a 39-year-old woman with a history of a prior left middle cerebral artery M2 occlusion with recent mechanical thrombectomy. The patient was found to have a 6-mm incidental, unruptured right internal cerebral artery paraophthalmic segment and 3-mm right posterior communicating artery aneurysm on radiographic studies. This patient underwent microsurgical clipping given unique patient factors. A similar controlled intradural clinoidectomy, with proximal cervical ICA control and aneurysmal segment trapping, allowed safe aneurysm exclusion. For patients with multiple aneurysms such as in these cases, the deeper proximal aneurysm should generally be treated first. The videos illustrate some key technical points in this regard.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Journal homepage: www.journals.elsevier.com/worldneurosurgery
Received 6 December 2018; accepted 9 March 2019
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
Citation: World Neurosurg. (2019) 126:398. https://doi.org/10.1016/j.wneu.2019.03.097
398
www.SCIENCEDIRECT.com
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.03.097
Microsurgical Clipping of Ophthalmic Aneurysms in an Endovascular Era: SonopetAssisted Intradural Clinoidectomy and Other Tenets Gregory Glauser and Omar A. Choudhri
Key words Aneurysm clipping - Cerebrovascular - Clinoidectomy - Multiple aneurysms - Ophthalmic artery aneurysm -
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA To whom correspondence should be addressed: Omar A. Choudhri, M.D. [E-mail: [email protected]] Supplementary digital content available online. Citation: World Neurosurg. (2019) 126:398. https://doi.org/10.1016/j.wneu.2019.03.097 Journal homepage: www.journals.elsevier.com/worldneurosurgery Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
These video cases present some unique technical tenets for microsurgical clipping of proximal internal carotid artery aneurysms (Video 1). The first patient is a 49-year-old woman with a history of a prior ruptured and treated right middle cerebral artery aneurysm who was found to have growth of known left middle cerebral artery and left internal carotid artery ophthalmic segment aneurysms on radiographic studies. An intradural clinoidectomy with Sonopet, with proximal control at cervical carotid and wide sylvian fissure exposure with ample sharp dissection of the aneurysm anatomy, allowed safe clipping of the ophthalmic aneurysm in this case. The second patient is a 39-year-old woman with a history of a prior left middle cerebral artery M2 occlusion with recent mechanical thrombectomy. The patient was found to have a 6-mm incidental, unruptured right internal cerebral artery paraophthalmic segment and 3-mm right posterior communicating artery aneurysm on radiographic studies. This patient underwent microsurgical clipping given unique patient factors. A similar controlled intradural clinoidectomy, with proximal cervical ICA control and aneurysmal segment trapping, allowed safe aneurysm exclusion. For patients with multiple aneurysms such as in these cases, the deeper proximal aneurysm should generally be treated first. The videos illustrate some key technical points in this regard.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Journal homepage: www.journals.elsevier.com/worldneurosurgery
Received 6 December 2018; accepted 9 March 2019
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2019 Published by Elsevier Inc.
Citation: World Neurosurg. (2019) 126:398. https://doi.org/10.1016/j.wneu.2019.03.097
398
www.SCIENCEDIRECT.com
WORLD NEUROSURGERY, https://doi.org/10.1016/j.wneu.2019.03.097