Cranio-orbital approach for the paraclinoidal and anterior communicating aneurysms

Souza, Jorge Marcondes de; Rodrigues, Flávio F.; Silva, Marcelo R. da; Maron, Ricardo; Martins, Leonardo; Souto, Antonio A. do; Lima, Luciara S.

doi:10.1590/S0004-282X1995000400007

Abstracts

Aneurysms arising at the proximal intracranial carotid artery (between cavernous sinus and posterior communicating artery) and at the anterior communicating complex may present with technical difficulties regarding appropriate access without excessive brain retraction. In a series of 15 patients the authors show the use of the cranio-orbital approach, formerly designed in the access of skull base tumors, for these subgroups of aneurysms. They discuss the advantages of a basal avenue in minimizing brain retraction, better anatomical orientation, obviation of tissue ressection and easier extra-dural bone removal. It was not identified any complication due to the described approach.

intracranial aneurysms; paraclinoidal aneurysms; skull base surgery; subarachnoid hemorrhage

Aneurismas situados junto à artéria carótida intracraniana proximal (entre seio cavernoso e artéria comunicante posterior) e ao nível do complexo comunicante anterior podem apresentar dificuldades técnicas relacionadas ao acesso apropriado sem retração cerebral excessiva. Em uma série de 15 pacientes os autores mostram o uso do acesso crânio-orbital, utilizado inicialmente para abordagem a tumores da base do crânio, para esses subgrupos de aneurismas. Discutem suas vantagens em minimizar retração, melhor orientação anatômica, evitar ressecção de tecido neural e facilitar remoção óssea. Não foi identificada qualquer complicação devida ao acesso descrito.

aneurisma intracraniano; aneurisma paraclinóideo; cirurgia da base do crânio; hemorragia subaracnóidea

Cranio-orbital approach for the paraclinoidal and anterior communicating aneurysms

Acesso crânio-orbital para aneurismas paraclinóideos e da comunicante anterior

Jorge Marcondes de Souza^I; Flávio F. Rodrigues^II; Marcelo R. da Silva^III; Ricardo Maron^III; Leonardo Martins^IV; Antonio A. do Souto^IV; Luciara S. Lima^IV

^IProfessor of Neurosurgery. Service of Neurosurgery, Department of Surgery, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. (UFRJ)

^IIProfessor and Chief of Neurosurgery. Service of Neurosurgery, Department of Surgery, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. (UFRJ)

^IIIAssociated Neurosurgeon. Service of Neurosurgery, Department of Surgery, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. (UFRJ)

^IVResident. Service of Neurosurgery, Department of Surgery, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. (UFRJ)

SUMMARY

Aneurysms arising at the proximal intracranial carotid artery (between cavernous sinus and posterior communicating artery) and at the anterior communicating complex may present with technical difficulties regarding appropriate access without excessive brain retraction. In a series of 15 patients the authors show the use of the cranio-orbital approach, formerly designed in the access of skull base tumors, for these subgroups of aneurysms. They discuss the advantages of a basal avenue in minimizing brain retraction, better anatomical orientation, obviation of tissue ressection and easier extra-dural bone removal. It was not identified any complication due to the described approach.

Key words:intracranial aneurysms, paraclinoidal aneurysms, skull base surgery, subarachnoid hemorrhage.

RESUMO

Aneurismas situados junto à artéria carótida intracraniana proximal (entre seio cavernoso e artéria comunicante posterior) e ao nível do complexo comunicante anterior podem apresentar dificuldades técnicas relacionadas ao acesso apropriado sem retração cerebral excessiva. Em uma série de 15 pacientes os autores mostram o uso do acesso crânio-orbital, utilizado inicialmente para abordagem a tumores da base do crânio, para esses subgrupos de aneurismas. Discutem suas vantagens em minimizar retração, melhor orientação anatômica, evitar ressecção de tecido neural e facilitar remoção óssea. Não foi identificada qualquer complicação devida ao acesso descrito.

Palavras-chave: aneurisma intracraniano, aneurisma paraclinóideo, cirurgia da base do crânio, hemorragia subaracnóidea.

Texto completo disponível apenas em PDF.

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Aceite: 22-abril-1995.

Dr. Jorge Marcondes de Souza - Serviço de Neurocirurgia, Hospital Universitário Clementino Fraga Filho- Av. Brigadeiro Trompowsky s/n, Ilha do Fundão - 21941-590 Rio de Janeiro RJ - Brasil. Fax: 021 270 2193.

1. Al-Mefty O, Ayoubi S, Schenk M. Unlocking and entering the cavernous sinus. Persp Neurol Surg 1991, 2: 49-68.
2. Ammirati M, Spallone A, Ma J, Cheathan M, Becker D. An anatomicro surgical study of the temporal branch of the facial nerve. Neurosurgery 1993, 33:1038-1044.
3. Andrews R, Bringa J. A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 1993, 33:1052-1064.
4. Batjer HH, Kopitnik TA, Giller CA, Samson D. Surgery for the paraclinoidal carotid artery aneurysms. J Neurosurg 1994, 80: 650-658.
5. Dandy WE. Aneurysms of the anterior cerebral artery. JAMA 1942, 119:1253.
6. Day AL. Aneurysms of the ophthalmic segment: a clinical and anatomical analysis. J Neurosurg 1990, 72: 677-691.
7. Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 1985, 62:667-672.
8. Gardner WJ. Cerebral angiomas and aneurysms. Surg Clin North Am 1936, 16:1019-1030.
9. Jane JA, Park TS, Pobereskin LH, Winn R, Butter A. The supraorbital approach: technical note. Neurosurgery 1982, 11:537-542.
10. Origitano TC, Anderson D. Skull base approach for aneurysms. Surg Neurol 1993, 40:339-346.
11. Pool JL. Bifrontal craniotomy for anterior communicating aneurysms: J Neurosurg 1972, 36:212-220.
12. Rhoton AL, Inoue T. Microsurgical approaches to the cavernous sinus. Clin Neurosurg 1991, 37:391-439.
13. Sekhar LN, Kalia KK, Yonas H, Wright DC, Ching H. Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 1994, 35:472-483.
14. Smith RR, Al-Mefty O, Middleton TH. An orbitrocranial approach to complex aneurysms of the anterior circulation. Neurosurgery 1989, 24:385-391.
15. Yasargil ME, Fox JL, Ray MW. The operative approach to aneurysms of the anterior communicating artery. In Krayenbuhl H (ed). Advances and technical standards in neurosurgery. Stuttgart: Springer-Verlag, 1975, p. 113-170.

Publication Dates

Publication in this collection
20 Dec 2010
Date of issue
Sept 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Al-Mefty O, Ayoubi S, Schenk M. Unlocking and entering the cavernous sinus. Persp Neurol Surg 1991, 2: 49-68.

[2] 2. Ammirati M, Spallone A, Ma J, Cheathan M, Becker D. An anatomicro surgical study of the temporal branch of the facial nerve. Neurosurgery 1993, 33:1038-1044.

[3] 3. Andrews R, Bringa J. A review of brain retraction and recommendations for minimizing intraoperative brain injury. Neurosurgery 1993, 33:1052-1064.

[4] 4. Batjer HH, Kopitnik TA, Giller CA, Samson D. Surgery for the paraclinoidal carotid artery aneurysms. J Neurosurg 1994, 80: 650-658.

[5] 5. Dandy WE. Aneurysms of the anterior cerebral artery. JAMA 1942, 119:1253.

[6] 6. Day AL. Aneurysms of the ophthalmic segment: a clinical and anatomical analysis. J Neurosurg 1990, 72: 677-691.

[7] 7. Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 1985, 62:667-672.

[8] 8. Gardner WJ. Cerebral angiomas and aneurysms. Surg Clin North Am 1936, 16:1019-1030.

[9] 9. Jane JA, Park TS, Pobereskin LH, Winn R, Butter A. The supraorbital approach: technical note. Neurosurgery 1982, 11:537-542.

[10] 10. Origitano TC, Anderson D. Skull base approach for aneurysms. Surg Neurol 1993, 40:339-346.

[11] 11. Pool JL. Bifrontal craniotomy for anterior communicating aneurysms: J Neurosurg 1972, 36:212-220.

[12] 12. Rhoton AL, Inoue T. Microsurgical approaches to the cavernous sinus. Clin Neurosurg 1991, 37:391-439.

[13] 13. Sekhar LN, Kalia KK, Yonas H, Wright DC, Ching H. Cranial base approaches to intracranial aneurysms in the subarachnoid space. Neurosurgery 1994, 35:472-483.

[14] 14. Smith RR, Al-Mefty O, Middleton TH. An orbitrocranial approach to complex aneurysms of the anterior circulation. Neurosurgery 1989, 24:385-391.

[15] 15. Yasargil ME, Fox JL, Ray MW. The operative approach to aneurysms of the anterior communicating artery. In Krayenbuhl H (ed). Advances and technical standards in neurosurgery. Stuttgart: Springer-Verlag, 1975, p. 113-170.