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Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy

Fusiform or near-fusiform aneurysms that involve the long segment of the supraclinoid internal carotid artery (ICA) pose significant challenges to neurovascular surgeons. Involvement of the origin of vital branching arteries in this segment may preclude safe treatment with flow diverting stents. In...

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Autores principales: Baykal, Duygu, Ozaydin, Burak, Erginoglu, Ufuk, Baskaya, Mustafa K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440854/
https://www.ncbi.nlm.nih.gov/pubmed/36068888
http://dx.doi.org/10.1055/s-0041-1726425
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author Baykal, Duygu
Ozaydin, Burak
Erginoglu, Ufuk
Baskaya, Mustafa K.
author_facet Baykal, Duygu
Ozaydin, Burak
Erginoglu, Ufuk
Baskaya, Mustafa K.
author_sort Baykal, Duygu
collection PubMed
description Fusiform or near-fusiform aneurysms that involve the long segment of the supraclinoid internal carotid artery (ICA) pose significant challenges to neurovascular surgeons. Involvement of the origin of vital branching arteries in this segment may preclude safe treatment with flow diverting stents. In addition, clip reconstruction may also not be possible in this region due to entire or near-entire involvement of the circumference of the ICA ( Fig. 1 ). In this video article, we present a case of a complex and previously leaked, (visualized with hemosiderin) aneurysm of the posterior communicating segment of the ICA, in a 60-year-old female. Multiple complexities made this aneurysm challenging to treat. These included (1) a 270-degree encirclement of the ICA with multiple lobulations that left only a small section of nondiseased vessel wall, (2) a relatively short segment of the supraclinoidal ICA that made proximal control challenging thus requiring an extradural anterior clinoidectomy, (3) a fetal posterior communicating artery that originated immediately proximal to the beginning of the aneurysm, and lastly, (4) an anterior choroidal artery that was firmly adherent over the aneurysm dome. In this video, we present the microsurgical steps for dealing with this complex aneurysm, including extradural clinoidectomy and clip reconstruction ( Fig. 2 ). Postoperatively, the patient woke up without any deficits. Angiography showed complete obliteration of the aneurysm. The link to the video can be found at: https://youtu.be/3Zz-ecvlDIc .
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spelling pubmed-94408542022-09-05 Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy Baykal, Duygu Ozaydin, Burak Erginoglu, Ufuk Baskaya, Mustafa K. J Neurol Surg B Skull Base Fusiform or near-fusiform aneurysms that involve the long segment of the supraclinoid internal carotid artery (ICA) pose significant challenges to neurovascular surgeons. Involvement of the origin of vital branching arteries in this segment may preclude safe treatment with flow diverting stents. In addition, clip reconstruction may also not be possible in this region due to entire or near-entire involvement of the circumference of the ICA ( Fig. 1 ). In this video article, we present a case of a complex and previously leaked, (visualized with hemosiderin) aneurysm of the posterior communicating segment of the ICA, in a 60-year-old female. Multiple complexities made this aneurysm challenging to treat. These included (1) a 270-degree encirclement of the ICA with multiple lobulations that left only a small section of nondiseased vessel wall, (2) a relatively short segment of the supraclinoidal ICA that made proximal control challenging thus requiring an extradural anterior clinoidectomy, (3) a fetal posterior communicating artery that originated immediately proximal to the beginning of the aneurysm, and lastly, (4) an anterior choroidal artery that was firmly adherent over the aneurysm dome. In this video, we present the microsurgical steps for dealing with this complex aneurysm, including extradural clinoidectomy and clip reconstruction ( Fig. 2 ). Postoperatively, the patient woke up without any deficits. Angiography showed complete obliteration of the aneurysm. The link to the video can be found at: https://youtu.be/3Zz-ecvlDIc . Georg Thieme Verlag KG 2021-04-08 /pmc/articles/PMC9440854/ /pubmed/36068888 http://dx.doi.org/10.1055/s-0041-1726425 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Baykal, Duygu
Ozaydin, Burak
Erginoglu, Ufuk
Baskaya, Mustafa K.
Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title_full Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title_fullStr Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title_full_unstemmed Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title_short Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy
title_sort clip reconstruction of a previously leaked large complex posterior communicating segment aneurysm with extradural anterior clinoidectomy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440854/
https://www.ncbi.nlm.nih.gov/pubmed/36068888
http://dx.doi.org/10.1055/s-0041-1726425
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