Download PDF
J Neurol Surg B Skull Base 2018; 79(05): 427-436
DOI: 10.1055/s-0037-1615804
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and the Skull Base

Satoshi Matsuo
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
2   Department of Neurosurgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
,
Noritaka Komune
3   Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
,
Ryosuke Tsuchimochi
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
,
Yasutoshi Kai
4   Department of Neurosurgery, Iizuka Hospital, Fukuoka, Japan
,
Kenichi Matsumoto
5   Department of Neurosurgery, Saga Medical Center Koseikan, Saga, Japan
,
Sei Haga
6   Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan
,
Takuya Inoue
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
› Author Affiliations
Further Information

Publication History

08 July 2017

19 November 2017

Publication Date:
29 December 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to review the anatomical and clinical characteristics of internal carotid-posterior communicating artery (IC-PC) aneurysms, especially those located close to the skull base.

Methods The microsurgical anatomy around the posterior communicating artery (PComA) was examined in a dry skull and five formalin-fixed human cadaveric heads. The clinical characteristics of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed.

Results The anterior clinoid process (ACP), as well as the anterior petroclinoidal dural fold (APF), which forms part of the oculomotor triangle, are closely related to the origin of the PComA. Among the 39 IC-PC aneurysms, anterior clinoidectomy was performed on 4 (10.3%) and a partial resection of the APF was performed on 2 (5.1%). Both of these aneurysms projected inferior to the tentorium, or at least part of the aneurysm's dome was inferior to the tentorium.

Conclusion Proximally located IC-PC aneurysms have an especially close relationship with the ACP and APF. We should be familiar with the anatomical relationship between IC-PC aneurysms and the structures of the skull base to avoid hazardous complications.

Keywords

anterior clinoid process - anterior petroclinoidal dural fold - internal carotid artery - posterior communicating artery - skull base

Disclosure

The authors have no personal financial or institutional interest in any of the materials or devices described in this article. Part of this work was supported by the University of Florida Foundation.


 

  • References

  • 1 Rhoton Jr AL. Aneurysms. Neurosurgery 2002; 51 (4, Suppl): S121-S158
    PubMedGoogle Scholar
  • 2 Lawton MT. Seven Aneurysms: Tenets and Techniques for Clipping. New York: Thieme; 2011: 45-64
    Google Scholar
  • 3 Golshani K, Ferrell A, Zomorodi A, Smith TP, Britz GW. A review of the management of posterior communicating artery aneurysms in the modern era. Surg Neurol Int 2010; 1 (01) 88
    CrossrefPubMedGoogle Scholar
  • 4 Sanai N, Caldwell N, Englot DJ, Lawton MT. Advanced technical skills are required for microsurgical clipping of posterior communicating artery aneurysms in the endovascular era. Neurosurgery 2012; 71 (02) 285-294 , discussion 294–295
    CrossrefPubMedGoogle Scholar
  • 5 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 2014; 37 (04) 637-641
    CrossrefPubMedGoogle Scholar
  • 6 Kim JH, Kim JM, Cheong JH, Bak KH, Kim CH. Simple anterior petroclinoid fold resection in the treatment of low-lying internal carotid-posterior communicating artery aneurysms. Surg Neurol 2009; 72 (02) 142-145
    CrossrefPubMedGoogle Scholar
  • 7 Takahashi JA, Kawarazaki A, Hashimoto N. Intradural en-bloc removal of the anterior clinoid process. Acta Neurochir (Wien) 2004; 146 (05) 505-509
    CrossrefPubMedGoogle Scholar
  • 8 Seifert V, Güresir E, Vatter H. Exclusively intradural exposure and clip reconstruction in complex paraclinoid aneurysms. Acta Neurochir (Wien) 2011; 153 (11) 2103-2109
    CrossrefPubMedGoogle Scholar
  • 9 Huynh-Le P, Natori Y, Sasaki T. Surgical anatomy of the anterior clinoid process. J Clin Neurosci 2004; 11 (03) 283-287
    CrossrefPubMedGoogle Scholar
  • 10 Yasuda A, Campero A, Martins C, Rhoton Jr AL, de Oliveira E, Ribas GC. Microsurgical anatomy and approaches to the cavernous sinus. Neurosurgery 2008; 62 (06) (Suppl. 03) 1240-1263
    PubMedGoogle Scholar
  • 11 Rhoton Jr AL. The sellar region. Neurosurgery 2002; 51 (4, Suppl): S335-S374
    CrossrefPubMedGoogle Scholar
  • 12 Ota N, Tanikawa R, Miyazaki T. , et al. Surgical microanatomy of the anterior clinoid process for paraclinoid aneurysm surgery and efficient modification of extradural anterior clinoidectomy. World Neurosurg 2015; 83 (04) 635-643
    CrossrefPubMedGoogle Scholar
  • 13 Rhoton Jr AL. Tentorial incisura. Neurosurgery 2000; 47 (3, Suppl): S131-S153
    CrossrefPubMedGoogle Scholar
  • 14 Martins C, Yasuda A, Campero A, Rhoton Jr AL. Microsurgical anatomy of the oculomotor cistern. Neurosurgery 2006; 58 (04) (Suppl. 02) ONS-220-ONS-227 , discussion ONS-227–ONS-228
    Google Scholar
  • 15 González-Darder JM, Quilis-Quesada V, Talamantes-Escribá F, Botella-Maciá L, Verdú-López F. Microsurgical relations between internal carotid artery-posterior communicating artery (ICA-PComA) segment aneurysms and skull base: an anatomoclinical study. J Neurol Surg B Skull Base 2012; 73 (05) 337-341
    PubMedGoogle Scholar
  • 16 Morita A, Kirino T, Hashi K. , et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482
    CrossrefPubMedGoogle Scholar
  • 17 Molyneux A, Kerr R, Stratton I. , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360 (9342): 1267-1274
    CrossrefPubMedGoogle Scholar
  • 18 Wiebers DO, Whisnant JP, Huston III J. , et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378): 103-110
    CrossrefPubMedGoogle Scholar
  • 19 Day JD, Giannotta SL, Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 1994; 81 (02) 230-235
    CrossrefPubMedGoogle Scholar
  • 20 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 2010; 48 (03) 199-206
    CrossrefPubMedGoogle Scholar
  • 21 Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 1983; 58 (06) 824-831
    CrossrefPubMedGoogle Scholar
  • 22 Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 1985; 62 (05) 667-672
    CrossrefPubMedGoogle Scholar
  • 23 Hakuba A, Tanaka K, Suzuki T, Nishimura S. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 1989; 71 (5 Pt 1): 699-704
    CrossrefPubMedGoogle Scholar
  • 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) 1989; 99 (3-4): 117-121
    CrossrefPubMedGoogle Scholar
  • 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 2009; 65 (02) 281-285 , discussion 285–286
    CrossrefPubMedGoogle Scholar
  • 26 Velat GJ, Zabramski JM, Nakaji P, Spetzler RF. Surgical management of giant posterior communicating artery aneurysms. Neurosurgery 2012; 71 (1, Suppl Operative): 43-50 , discussion 51
    PubMedGoogle Scholar
  • 27 Shimizu S, Yamamichi A, Tanioka S. , et al. Clinical analysis of microsurgical clipping of internal carotid-posterior communicating artery aneurysms (IC-PC ANs) with anterior clinoidectomy. Surg Cereb Stroke (Jpn) 2013; 41 (02) 137-142
    CrossrefPubMedGoogle Scholar
  • 28 Kulwin C, Tubbs RS, Cohen-Gadol AA. Anterior clinoidectomy: description of an alternative hybrid method and a review of the current techniques with an emphasis on complication avoidance. Surg Neurol Int 2011; 2: 140
    CrossrefPubMedGoogle Scholar
  • 29 Lehmberg J, Krieg SM, Meyer B. Anterior clinoidectomy. Acta Neurochir (Wien) 2014; 156 (02) 415-419 , discussion 419
    CrossrefPubMedGoogle Scholar
  • 30 Yonekawa Y, Ogata N, Imhof HG. , et al. Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 1997; 87 (04) 636-642
    CrossrefPubMedGoogle Scholar
  • 31 Erturk M, Kayalioglu G, Govsa F. Anatomy of the clinoidal region with special emphasis on the caroticoclinoid foramen and interclinoid osseous bridge in a recent Turkish population. Neurosurg Rev 2004; 27 (01) 22-26
    CrossrefPubMedGoogle Scholar
  • 32 Boyan N, Ozsahin E, Kizilkanat E, Tekdemir I, Soames R, Oguz O. Surgical importance of the morphometry of the anterior clinoid process, optic strut, caroticoclinoid foramen, and interclinoid osseous bridge. Neurosurg Q 2011; 21 (02) 133-136
    CrossrefPubMedGoogle Scholar
  • 33 Ozawa T, Takahashi S, Aiba T. IC-PC aneurysm clipping with opening of the oculomotor cistern. Surg Cereb Stroke (Jpn) 2007; 35 (04) 312-316
    CrossrefPubMedGoogle Scholar
  • 34 Skrzat J, Walocha J, Jaworek JK, Mróz I. The clinical significance of the petroclinoid ligament. Folia Morphol (Warsz) 2007; 66 (01) 39-43
    PubMedGoogle Scholar
  • 35 Tsutsumi S, Miranda JC, Ono H, Yasumoto Y. The cisternal segments of the oculomotor nerve: a magnetic resonance imaging study. Surg Radiol Anat 2017; 39 (03) 323-331
    CrossrefPubMedGoogle Scholar
  • 36 Takami T, Ohata K, Nishikawa M. , et al. Transposition of the oculomotor nerve for resection of a midbrain cavernoma. Technical note. J Neurosurg 2003; 98 (04) 913-916
    CrossrefPubMedGoogle Scholar