Journal of Korean Neurosurgical Society

  • 제67권4호
  • /
  • Pages.411-417
  • /
  • 2024
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

The Usefulness of Extradural Anterior Clinoidectomy for Low-Lying Posterior Communicating Artery Aneurysms : A Cadaveric Study

  • Hyoung Soo Byoun (Department of Neurosurgery, Chungnam National University Sejong Hospital) ;
  • Kyu-Sun Choi (Department of Neurosurgery, College of Medicine, Hanyang University) ;
  • Min Kyun Na (Department of Neurosurgery, College of Medicine, Hanyang University) ;
  • Sae Min Kwon (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Yong Seok Nam (Department of Anatomy, College of Korean Medicine, Dongshin University)
  • 투고 : 2023.08.29
  • 심사 : 2023.12.05
  • 발행 : 2024.07.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : To confirm the usefulness of the extradural anterior clinoidectomy during the clipping of a low riding posterior communicating artery (PCoA) aneurysm through cadaver dissection. Methods : Anatomic measurements of 12 adult cadaveric heads (24 sides total) were performed to compare the microsurgical exposure of the PCoA and internal carotid artery (ICA) before and after clinoidectomy. A standard pterional craniotomy and transsylvian approach were performed in all cadavers. The distance from the ICA bifurcation to the origin of PCoA (D1), pre-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D2), post-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D3), pre-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D4) and post-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D5) and the distance of the ICA obtained after anterior clinoidectomy (D6) were measured. We measured the precise thickness of the blade for the Yasargil clip with a digital precision ruler to confirm the usefulness of the extradural anterior clinoidectomy. Results : Twenty-four sites were dissected from 12 cadavers. The age of the cadavers was 79.83±6.25 years. The number of males was the same as the females. The space from the proximal origin of the PCoA to the preclinoid-tentorium (D4) was 1.45±1.08 mm (max, 4.01; min, 0.56). After the clinoidectomy, the space from the proximal origin of the PCoA to the postclinoid-tentorium (D5) was 3.612±1.15 mm (max, 6.14; min, 1.83). The length (D6) of the exposed proximal ICA after the extradural clinoididectomy was 2.17±1.04 mm on the lateral side and 2.16±0.89 mm on the medial side. The thickness of the Yasargil clip blade used during the clipping surgery was 1.35 mm measured with a digital precision ruler. Conclusion : The proximal length obtained by performing an external anterior clinoidectomy is about 2 mm, sufficient for proximal control during PCoA aneurysm surgery, considering the thickness of the aneurysm clips. In a subarachnoid hemorrhage, performing an extradural anterior clinoidectomy could prevent a devastating situation during PCoA aneurysm clipping.

키워드

참고문헌

  1. Almekhlafi MA, Al Sultan AS, Kuczynski AM, Brinjikji W, Menon BK, Hill MD, et al. : Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms. J Neurointerv Surg 12 : 298-302, 2020
  2. Chang HS, Joko M, Song JS, Ito K, Inoue T, Nakagawa H : Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg 104 : 621-624, 2006
  3. Evans JJ, Hwang YS, Lee JH : Pre- versus post-anterior clinoidectomy measurements of the optic nerve, internal carotid artery, and opticocarotid triangle: a cadaveric morphometric study. Neurosurgery 46 : 1018-1021; discussion 1021-1023, 2000
  4. Froelich SC, Aziz KM, Levine NB, Theodosopoulos PV, van Loveren HR, Keller JT : Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery 61 : 179-185; discussion 185-186, 2007
  5. Golnari P, Nazari P, Garcia RM, Weiss H, Shaibani A, Hurley MC, et al. : Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993-2015): continued evolution versus steady-state after more than 2 decades of practice. J Neurosurg 134 : 848-861, 2020
  6. Goncalves Pacheco Junior M, de Melo Junior JO, Andre Acioly M, Mansilla Cabrera Rodrigues R, Lima Pessoa B, Fernandes RA, et al. : Tailored anterior clinoidectomy: beyond the intradural and extradural concepts. Cureus 13 : e14874, 2021
  7. Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, et al. : Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol 72 : 764-772, 2015
  8. Hwang G, Jung C, Park SQ, Kang HS, Lee SH, Oh CW, et al. : Thromboembolic complications of elective coil embolization of unruptured aneurysms: the effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery 67 : 743-748; discussion 748, 2010
  9. Hwang JS, Hyun MK, Lee HJ, Choi JE, Kim JH, Lee NR, et al. : Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 12 : 99, 2012
  10. Jiang Z, Chen Y, Zeng C, Feng J, Wan Y, Zhang X : Neurosurgical clipping versus endovascular coiling for patients with intracranial aneurysms: a systematic review and meta-analysis. World Neurosurg 138 : e191-e222, 2020
  11. Kamide T, Burkhardt JK, Tabani H, Safaee MM, Lawton MT : Preoperative prediction of the necessity for anterior clinoidectomy during microsurgical clipping of ruptured posterior communicating artery aneurysms. World Neurosurg 109 : e493-e501, 2018
  12. Kim CH, Hwang G, Kwon OK, Ban SP, Chinh ND, Tjahjadi M, et al. : P2Y12 reaction units threshold for implementing modified antiplatelet preparation in coil embolization of unruptured aneurysms: a prospective validation study. Radiology 282 : 542-551, 2017
  13. Kim DW, Kang SD : Association between internal carotid artery morphometry and posterior communicating artery aneurysm. Yonsei Med J 48 : 634-638, 2007
  14. Kim JH, Kim JM, Cheong JH, Bak KH, Kim CH : Simple anterior petroclinoid fold resection in the treatment of low-lying internal carotidposterior communicating artery aneurysms. Surg Neurol 72 : 142-145, 2009
  15. Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, et al. : Trends in the incidence and treatment of cerebrovascular diseases in Korea : part I. Intracranial aneurysm, intracerebral hemorrhage, and arteriovenous malformation. J Korean Neurosurg Soc 63 : 56-68, 2020
  16. Li W, Zhu W, Wang A, Zhang G, Zhang Y, Wang K, et al. : Effect of adjusted antiplatelet therapy on preventing ischemic events after stenting for intracranial aneurysms. Stroke 52 : 3815-3825, 2021
  17. Matano F, Murai Y, Mizunari T, Yamaguchi M, Yamada T, Baba E, et al. : Incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an internal carotid artery-posterior communicating artery aneurysm: a technical note. Neurosurg Rev 42 : 777-781, 2019
  18. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360 : 1267-1274, 2002
  19. Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS : The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet 385 : 691-697, 2015
  20. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005
  21. Nagasawa S, Kikuchi H, Kim NG, Yonekawa Y : Analysis of internal carotid-posterior communicating artery aneurysms with difficulty in clipping: with special reference to radiometry. No Shinkei Geka 16 : 959-964, 1988
  22. Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, et al. : Prediction of the difficulty of proximal vascular control using 3D-CTA for the surgical clipping of internal carotid artery-posterior communicating artery aneurysms. J Neurosurg 134 : 1165-1172, 2020
  23. Nossek E, Setton A, Dehdashti AR, Chalif DJ : Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms. Neurosurg Rev 37 : 637-641, 2014
  24. Ochiai C, Wakai S, Inou S, Nagai M : Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery. Acta Neurochir (Wien) 99 : 117-121, 1989
  25. Park SK, Shin YS, Lim YC, Chung J : Preoperative predictive value of the necessity for anterior clinoidectomy in posterior communicating artery aneurysm clipping. Neurosurgery 65 : 281-285; discussion 285-286, 2009
  26. Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J : Tailored anterior clinoidectomy through the lateral supraorbital approach: experience with 82 consecutive patients. World Neurosurg 77 : 512-517, 2012
  27. Salgado Lopez L, Munoz Hernandez F, Asencio Cortes C, Tresserras Ribo P, Alvarez Holzapfel MJ, Molet Teixido J : Extradural anterior clinoidectomy in the management of parasellar meningiomas: analysis of 13 years of experience and literature review. Neurocirugia (Astur : Engl Ed) 29 : 225-232, 2018
  28. Son HE, Park MS, Kim SM, Jung SS, Park KS, Chung SY : The avoidance of microsurgical complications in the extradural anterior clinoidectomy to paraclinoid aneurysms. J Korean Neurosurg Soc 48 : 199-206, 2010
  29. Tayebi Meybodi A, Lawton MT, Yousef S, Guo X, Gonzalez Sanchez JJ, Tabani H, et al. : Anterior clinoidectomy using an extradural and intradural 2-step hybrid technique. J Neurosurg 130 : 238-247, 2018
  30. Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, ChoqueVelasquez J, et al. : Microneurosurgical management of posterior communicating artery aneurysm: a contemporary series from Helsinki. World Neurosurg 101 : 379-388, 2017
  31. Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, et al. : Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 87 : 636-642, 1997