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DOI: 10.1055/s-0044-1795070
Intradural versus Extradural Anterior Clinoidectomy: Comparison of Visual Loss in Patients with Paraclinoid Aneurysms
Série de casos: Comparação da perda visual em pacientes submetidos a clinoidectomia intra versus extradural para abordagem de aneurismas paraclinoideosFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Abstract
Introduction Visual deficit after surgical treatment for paraclinoid aneurysms is a problem faced by many neurosurgeons. Anterior clinoidectomy, performed to access the aneurysm, is one the most important steps of the surgery. However, it is also the step related the most with lesions to the optic nerve. The aim of this study was to compare the rate of visual loss between extradural versus intradural clinoidectomy in patients harboring paraclinoid aneurysms which underwent open surgery.
Methods Analysis of 36 patients harboring paraclinoid aneurysms operated by the senior authors between 2020–2022. We compared our results to other series published previously.
Results Fifteen patients underwent intradural clinoidectomy (41.6%), twenty patients extradural clinoidectomy (55.5%) and one patient intra and extradural clinoidectomy (2.7%). The incidence of postoperative visual deterioration was 11.1% (4 patients), all of them were from the extradural clinoidectomy group. Other complications found were cerebrospinal fluid leak (1 patient) and vasospasm followed by diffuse ischemia (1 patient). Visual evoked potential was used in 6 patients (16.6%). In two cases VEP was normal during surgery, however they developed visual deterioration in the postoperative period.
Conclusion Both techniques have advantages and disadvantages, however extradural clinoidectomy showed higher rates of visual deterioration than intradural clinoidectomy. Regardless of the chosen procedure, precise surgical technique is mandatory when dealing with paraclinoid aneurysms.
Resumo
Introdução Déficit visual após abordagem microcirúrgica de aneurismas paraclinoideos é um problema encontrado por diversos neurocirurgiōes. Clinoidectomia anterior, realizada para obter acesso aos aneurismas paraclinoideos, é um dos passos fundamentais da abordagem cirúrgica, entretanto pode levar a lesões do nervo óptico. O objetivo deste estudo foi comparar a incidência de déficit visual em pacientes submetidos a clinoidectomia intradural versus aqueles submetidos a técnica extradural.
Métodos Análise de 36 casos operados no servico durante o período de 2020–2022. Os resultados foram comparados com outras séries previamente publicadas.
Resultados Clinoidectomia intradural foi realizada em 15 pacientes (41.6%), clinoidectomia extradural em 20 pacientes (55.5%) e abordagem combinada em 1 paciente (2.7%). A incidência de deficit visual no período pós-operatório foi de 11.1% (4 pacientes), todos do grupo extradural. Outras complicaçōes encontradas foram: fístula liquórica (1 paciente) e vasoespasmo difuso (1 paciente). Potencial evocado visual foi utilizado em 6 pacientes (16.6%). Em dois casos, o potencial permaneceu inalterado durante a cirurgia, entretanto houve deterioração visual no período pós-operatório.
Conclusão Ambas técnicas possuem vantagens e desvantagens, entretanto, a clinoidectomia extradural apresentou maior incidência de deficit visual nesse estudo. Independente da abordagem escolhida, uma técnica cirúrgica exímia é mandatória no manejo desses aneurismas.
Publikationsverlauf
Eingereicht: 17. Dezember 2023
Angenommen: 18. Oktober 2024
Artikel online veröffentlicht:
11. Dezember 2024
© 2024. Sociedade Brasileira de Neurocirurgia. 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/)
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