TY - JOUR
T1 - Direct suction decompression and fenestrated clip reconstruction of complex paraclinoid carotid artery aneurysm
T2 - Operative video and nuances of skull base technique
AU - Liu, James K.
N1 - Publisher Copyright: © AANS, 2015.
PY - 2015
Y1 - 2015
N2 - Direct microsurgical clipping of complex paraclinoid carotid artery aneuryms remains a formidable technical challenge due to the auneurysm's deep location at the skull base, with adjacent bony anatomy, large size, wide neck, and complex neuroanatomical relationships. In this operative video atlas manuscript, the author demonstrates a step-by-step technique for microsurgical clip reconstruction of a large complex ventral paraclinoid carotid artery aneurysm, using a trapping and direct suction decompression strategy followed by multiple fenestrated clip reconstruction of the internal carotid artery (ICA) via a modified orbitozygomatic approach. The nuances of skull base techniques are illustrated including extradural optic nerve decompression, extradural anterior clinoidectomy, incision of the falciform ligament to untether the optic nerve, and release of the distal dural ring to obtain proximal control. Reconstruction of the ICA and preservation of the anterior choroidal artery were achieved with multiple fenestrated clips. Aneurysm obliteration and patency of flow through the ICA was confirmed on video indocyanine green and catheter angiography. Although novel endovascular strategies continue to evolve, these microsurgical skull base techniques should remain in the surgical armamentarium for treating these complex cranial base vascular lesions.
AB - Direct microsurgical clipping of complex paraclinoid carotid artery aneuryms remains a formidable technical challenge due to the auneurysm's deep location at the skull base, with adjacent bony anatomy, large size, wide neck, and complex neuroanatomical relationships. In this operative video atlas manuscript, the author demonstrates a step-by-step technique for microsurgical clip reconstruction of a large complex ventral paraclinoid carotid artery aneurysm, using a trapping and direct suction decompression strategy followed by multiple fenestrated clip reconstruction of the internal carotid artery (ICA) via a modified orbitozygomatic approach. The nuances of skull base techniques are illustrated including extradural optic nerve decompression, extradural anterior clinoidectomy, incision of the falciform ligament to untether the optic nerve, and release of the distal dural ring to obtain proximal control. Reconstruction of the ICA and preservation of the anterior choroidal artery were achieved with multiple fenestrated clips. Aneurysm obliteration and patency of flow through the ICA was confirmed on video indocyanine green and catheter angiography. Although novel endovascular strategies continue to evolve, these microsurgical skull base techniques should remain in the surgical armamentarium for treating these complex cranial base vascular lesions.
KW - Complex cerebral aneurysm
KW - Fenestrated clip reconstruction
KW - Operative video
KW - Skull base surgery
KW - Suction decompression
KW - Trapping
KW - Ventral paraclinoid aneurysm
UR - http://www.scopus.com/inward/record.url?scp=84965090327&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84965090327&partnerID=8YFLogxK
U2 - https://doi.org/10.3171/2015.7.FocusVid.14573
DO - https://doi.org/10.3171/2015.7.FocusVid.14573
M3 - Article
C2 - 26132621
SN - 1092-0684
VL - 39
JO - Neurosurgical focus
JF - Neurosurgical focus
M1 - V4
ER -