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open access

Vol 54, No 2 (2020)
Research Paper
Submitted: 2019-10-06
Accepted: 2020-01-22
Published online: 2020-02-26
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Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography

Tomasz Szmuda12, Paweł Słoniewski1, Shan Ali2, Alexandra Kamieniecki2, Jarosław Dzierżanowski1
DOI: 10.5603/PJNNS.a2020.0017
·
Pubmed: 32101325
·
Neurol Neurochir Pol 2020;54(2):138-149.
Affiliations
  1. Neurosurgery Department, Medical University of Gdansk, Poland.
  2. Student’s Scientific Circle, Neurosurgery Department, Medical University of Gdansk, Poland.

open access

Vol 54, No 2 (2020)
Research papers
Submitted: 2019-10-06
Accepted: 2020-01-22
Published online: 2020-02-26

Abstract

Aim of study. We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs).

Clinical rationale for study. The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA.

Materials and methods. 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy
was compared to the extent of the actual clinoidectomy.

Results. 21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs.

Conclusions. The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures.

Clinical implications. Currently, the role of 3D-CTA planning is restricted to educational purposes only.

Abstract

Aim of study. We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs).

Clinical rationale for study. The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA.

Materials and methods. 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy
was compared to the extent of the actual clinoidectomy.

Results. 21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs.

Conclusions. The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures.

Clinical implications. Currently, the role of 3D-CTA planning is restricted to educational purposes only.

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Keywords

cerebral aneurysm, carotid-ophthalmic aneurysm, paraclinoid aneurysm, internal carotid artery, head computerised tomography angiography, anterior clinoid process, surgical clipping

About this article
Title

Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 54, No 2 (2020)

Article type

Research Paper

Pages

138-149

Published online

2020-02-26

Page views

1562

Article views/downloads

441

DOI

10.5603/PJNNS.a2020.0017

Pubmed

32101325

Bibliographic record

Neurol Neurochir Pol 2020;54(2):138-149.

Keywords

cerebral aneurysm
carotid-ophthalmic aneurysm
paraclinoid aneurysm
internal carotid artery
head computerised tomography angiography
anterior clinoid process
surgical clipping

Authors

Tomasz Szmuda
Paweł Słoniewski
Shan Ali
Alexandra Kamieniecki
Jarosław Dzierżanowski

References (39)
  1. Falk Delgado A, Andersson T, Falk Delgado A. Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping. Br J Neurosurg. 2017; 31(3): 345–349.
    CrossRefPubMed
  2. Orlický M, Sameš M, Hejčl A, et al. Carotid-ophthalmic aneurysms-Our results and treatment strategy. Br J Neurosurg. 2015; 29(2): 237–242.
    CrossRefPubMed
  3. Sai Kiran NA, Sivaraju L, Vidyasagar K, et al. Intradural "limited drill" technique of anterior clinoidectomy and optic canal unroofing for microneurosurgical management of ophthalmic segment and PCOM aneurysms-review of surgical results. Neurosurg Rev. 2018 [Epub ahead of print].
    CrossRefPubMed
  4. Kamide T, Tabani H, Safaee MM, et al. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg. 2018; 129(6): 1511–1521.
    CrossRefPubMed
  5. Rafiei A, Hafez A, Jahromi BR, et al. Anatomic Features of Paraclinoid Aneurysms: Computed Tomography Angiography Study of 144 Aneurysms in 136 Consecutive Patients. Neurosurgery. 2017; 81(6): 949–957.
    CrossRefPubMed
  6. Lindgren A, Vergouwen MDI, van der Schaaf I, et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2018; 8: CD003085.
    CrossRefPubMed
  7. Kimura T, Morita A. Early Visualization of Optic Canal for Safe Anterior Clinoidectomy: Operative Technique and Supporting Computed Tomography Findings. World Neurosurg. 2019; 126: e447–e452.
    CrossRefPubMed
  8. Kulwin C, Tubbs RS, Cohen-Gadol AA. Anterior clinoidectomy: Description of an alternative hybrid method and a review of the current techniques with an emphasis on complication avoidance. Surg Neurol Int. 2011; 2: 140.
    CrossRefPubMed
  9. Szmuda T, Sloniewski P, Baczalska A, et al. The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively. Folia Morphol (Warsz). 2013; 72(2): 100–106.
    CrossRefPubMed
  10. Romani R, Elsharkawy A, Laakso A, et al. Tailored anterior clinoidectomy through the lateral supraorbital approach: experience with 82 consecutive patients. World Neurosurg. 2012; 77(3-4): 512–517.
    CrossRefPubMed
  11. Froelich SC, Aziz KM, Levine NB, et al. Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery. 2007; 61(5 Suppl 2): 179–85; discussion 185.
    CrossRefPubMed
  12. Iwasaki K, Toda H, Hashikata H, et al. Extradural Anterior Clinoidectomy and Optic Canal Unroofing for Paraclinoid and Basilar Aneurysms: Usefulness of a No-Drill Instrumental Method. Acta Neurochir Suppl. 2018; 129: 39–42.
    CrossRefPubMed
  13. Andaluz N, Beretta F, Bernucci C, et al. Evidence for the improved exposure of the ophthalmic segment of the internal carotid artery after anterior clinoidectomy: morphometric analysis. Acta Neurochir (Wien). 2006; 148(9): 971–5; discussion 975.
    CrossRefPubMed
  14. Ota N, Tanikawa R, Miyazaki T, et al. Surgical microanatomy of the anterior clinoid process for paraclinoid aneurysm surgery and efficient modification of extradural anterior clinoidectomy. World Neurosurg. 2015; 83(4): 635–643.
    CrossRefPubMed
  15. Hayashi N, Masuoka T, Tomita T, et al. Surgical anatomy and efficient modification of procedures for selective extradural anterior clinoidectomy. Minim Invasive Neurosurg. 2004; 47(6): 355–358.
    CrossRefPubMed
  16. Takahashi JA, Kawarazaki A, Hashimoto N. Intradural en-bloc removal of the anterior clinoid process. Acta Neurochir (Wien). 2004; 146(5): 505–509.
    CrossRefPubMed
  17. Seifert V, Güresir E, Vatter H. Exclusively intradural exposure and clip reconstruction in complex paraclinoid aneurysms. Acta Neurochir (Wien). 2011; 153(11): 2103–2109.
    CrossRefPubMed
  18. Kikuta KI, Kitai R, Kodera T, et al. Predictive Factors for the Occurrence of Visual and Ischemic Complications After Open Surgery for Paraclinoid Aneurysms of the Internal Carotid Artery. Acta Neurochir Suppl. 2016; 123: 41–49.
    CrossRefPubMed
  19. Romani R, Elsharkawy A, Laakso A, et al. Complications of anterior clinoidectomy through lateral supraorbital approach. World Neurosurg. 2012; 77(5-6): 698–703.
    CrossRefPubMed
  20. Kshettry VR, Jiang X, Chotai S, et al. Optic nerve surface temperature during intradural anterior clinoidectomy: a comparison between high-speed diamond burr and ultrasonic bone curette. Neurosurg Rev. 2014; 37(3): 453–8; discussion 458.
    CrossRefPubMed
  21. Barnett SL, Whittemore B, Thomas J, et al. Intradural clinoidectomy and postoperative headache in patients undergoing aneurysm surgery. Neurosurgery. 2010; 67(4): 906–9; discussion 910.
    CrossRefPubMed
  22. Tripathi M, Deo RC, Damodaran N, et al. Quantitative analysis of variable extent of anterior clinoidectomy with intradural and extradural approaches: 3-dimensional analysis and cadaver dissection. Neurosurgery. 2015; 11 Suppl 2: 147–60; discussion 160.
    CrossRefPubMed
  23. Ochiai C, Wakai S, Inou S, et al. Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery. Acta Neurochir (Wien). 1989; 99(3-4): 117–121.
    CrossRefPubMed
  24. Kamide T, Burkhardt JK, Tabani H, et al. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms. World Neurosurg. 2018; 109: e493–e501.
    CrossRefPubMed
  25. Park SK, Shin YS, Lim YC, et al. Preoperative predictive value of the necessity for anterior clinoidectomy in posterior communicating artery aneurysm clipping. Neurosurgery. 2009; 65(2): 281–5; discussion 285.
    CrossRefPubMed
  26. Lee HW, Park HS, Yoo KS, et al. Measurement of Critical Structures around Paraclinoidal Area : A Cadaveric Morphometric Study. J Korean Neurosurg Soc. 2013; 54(1): 14–18.
    CrossRefPubMed
  27. Batjer HH, Welch BG. Respecting the Clinoid: An Application of Preoperative Computed Tomography Angiography. World Neurosurg. 2015; 83(6): 1022–1023.
    CrossRefPubMed
  28. Bouthillier A, Loveren Hv, Keller J. Segments of the Internal Carotid Artery: A New Classification. Neurosurgery. 1996; 38(3): 425–433.
    CrossRef
  29. Pechlivanis I, Schmieder K, Scholz M, et al. 3-Dimensional computed tomographic angiography for use of surgery planning in patients with intracranial aneurysms. Acta Neurochir (Wien). 2005; 147(10): 1045–53; discussion 1053.
    CrossRefPubMed
  30. Kawashima M, Matsushima T, Miyazono M, et al. Two surgical cases of internal carotid-ophthalmic artery aneurysms: special reference to the usefulness of three-dimensional CT angiography. Neurol Res. 2002; 24(8): 825–828.
    CrossRefPubMed
  31. Motoyama Y, Hironaka Y, Nishimura F, et al. Quantitative analysis of the trajectory of simulated basilar apex aneurysms through the internal carotid artery to assess the need for an orbitozygomatic approach. Acta Neurochir (Wien). 2017; 159(1): 85–92.
    CrossRefPubMed
  32. da Costa MD, de Oliveira Santos BF, de Araujo Paz D, et al. Anatomical Variations of the Anterior Clinoid Process: A Study of 597 Skull Base Computerized Tomography Scans. Oper Neurosurg (Hagerstown). 2016; 12(3): 289–297.
    CrossRefPubMed
  33. Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg. 1985; 62(5): 667–672.
    CrossRefPubMed
  34. Vajkoczy P. Intradural versus extradural removal of the anterior clinoid process. World Neurosurg. 2012; 77(5-6): 615–616.
    CrossRefPubMed
  35. Otani N, Muroi C, Yano H, et al. Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy. Br J Neurosurg. 2006; 20(3): 129–138.
    CrossRefPubMed
  36. Chang DJ. The "no-drill" technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region. Neurosurgery. 2009; 64(3 Suppl): ons96–105; discussion ons105.
    CrossRefPubMed
  37. Spektor S, Dotan S, Mizrahi CJ. Safety of drilling for clinoidectomy and optic canal unroofing in anterior skull base surgery. Acta Neurochir (Wien). 2013; 155(6): 1017–1024.
    CrossRefPubMed
  38. Yonekawa Y, Ogata N, Imhof HG, et al. Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg. 1997; 87(4): 636–642.
    CrossRefPubMed
  39. Khan N, Yoshimura S, Roth P, et al. Conventional microsurgical treatment of paraclinoid aneurysms: state of the art with the use of the selective extradural anterior clinoidectomy SEAC. Acta Neurochir Suppl. 2005; 94: 23–29.
    CrossRefPubMed

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