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논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2013.1
- 수록면
- 477 - 483 (7page)
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Objective : Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications. Methods : Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography. Results : Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely. Conclusion : The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.
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참고문헌 (39)
참고문헌 신청
Barami K / 2003 / Paraclinoid Carotid Aneurysms : Surgical Management, Complications, and Outcome Based on a New Classification Scheme / Skull Base 13:31~41
Batjer HH / 1994 / Surgery for paraclinoidal carotid artery aneurysms / J Neurosurg 80:650~658
Beretta F / 2004 / The paraclinoid aneurysms and the distal dural ring : a new classification / J Neurosurg Sci 48:161~175
Chang DJ / 2009 / The “no-drill” technique of anterior clinoidectomy : a cranial base approach to the paraclinoid and parasellar region / Neurosurgery 64(3 Suppl):ons96~ons105
Colli BO / 2013 / Results of microsurgical treatment of paraclinoid carotid aneurysms / Neurosurg Rev 36:99~114
Batjer HH / 1994 / Surgery for paraclinoidal carotid artery aneurysms / J Neurosurg 80:650~658
Beretta F / 2004 / The paraclinoid aneurysms and the distal dural ring : a new classification / J Neurosurg Sci 48:161~175
Chang DJ / 2009 / The “no-drill” technique of anterior clinoidectomy : a cranial base approach to the paraclinoid and parasellar region / Neurosurgery 64(3 Suppl):ons96~ons105
Colli BO / 2013 / Results of microsurgical treatment of paraclinoid carotid aneurysms / Neurosurg Rev 36:99~114
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