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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 870-876
DOI: 10.4103/ajns.AJNS_305_20
Original Article

Intradural versus extradural location of paraclinoid aneurysms: Preoperative red flag markers

Anuj Bhide
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Yashuhiro Yamada
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Yoko Kato
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Nidhisha Sadhwani
Department of Neurosurgery, Grant Govt. Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra
,
Tsukasa Kawase
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Riki Tanaka
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Kyosuke Miyatani
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
,
Daijiro Kojima
Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya
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Background: Exact preoperative confirmation of the distal dural ring and intradural location of a paraclinoid internal carotid aneurysm has been an age old dilemma. This study was aimed at identifying anatomical landmarks in cases of paraclinoid aneurysms, which were relatively consistent, and would help in predicting the possibility of an extradural inaccessible location of these aneurysms for surgical clipping. Methods: Ninety surgically managed unruptured paraclinoid aneurysms were retrospectively analyzed with preoperative computerized tomography. Axial relation of the aneurysm neck to the ophthalmic artery (OA), optic strut (OS), and anterior clinoid process (ACP) in terms of vertical distance and the direction of projection were analyzed and tabulated for all 90 cases. Intradural and extradural (inaccessible) aneurysms were compared. Results: Seven out of the 8 inaccessible necks were medially directed and 1 was ventrally placed (P = 0.053). The OA level when compared to the neck had a positive correlation with inaccessible aneurysms for clipping (P = 0.002) The OS location above the level of the neck had significant correlation with inaccessibility of clipping and extradural location (P < 0.001). The tip of the ACP had no statistical significance with inaccessibility (P = 0.351). Conclusions: Medially projecting aneurysms with necks below the level of the OS and origin of the OA should be managed with a high index of suspicion and an alternate method of treatment should be sought. The relation of the neck to the ACP does not seem to have significant statistical bearing with decision making.

Key-words:

Anterior clinoid process - distal dural ring - extradural aneurysm - ophthalmic artery - optic strut - paraclinoid aneurysm

Financial support and sponsorship

Nil.




Publication History

Received: 20 June 2020

Accepted: 10 August 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. 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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  • References

  • 1 Chih-Hsiang L, Lin CJ, Lin CF, Huang HY, Chen MH, Hsu SP, et al. Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography. J Neurosurg JNS 2016125, 2:275-82.
  • 2 Lee N, Jung JY, Huh SK, Kim DJ, Kim DI, Kim J. Distinction between intradural and extradural aneurysms involving the paraclinoid internal carotid artery with T2-weighted three-dimensional fast spin-echo magnetic resonance imaging. J Korean Neurosurg Soc 2010;47:437-41.
  • 3 Taptas JN. Intradural and extradural ICA. J Neurosurg 1979;51:877-8.
  • 4 Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: A new classification. Neurosurgery 1996;38:425-32.
  • 5 Oikawa S, Kyoshima K, Kobayashi S. Surgical anatomy of the juxta-dural ring area. J Neurosurg 1998;89:250-4.
  • 6 De Jesús O, Sekhar LN, Riedel CJ. Clinoid and paraclinoid aneurysms: Surgical anatomy, operative techniques, and outcome. Surg Neurol 1999;51:477-87.
  • 7 Barr HW, Blackwood W, Meadows SP. Intracavernous carotid aneurysms. A clinical-pathological report. Brain 1971;94:607-22.
  • 8 Kupersmith MJ, Hurst R, Berenstein A, Choi IS, Jafar J, Ransohoff J. The benign course of cavernous carotid artery aneurysms. J Neurosurg 1992;77:690-3.
  • 9 Punt J. Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 1979;51:151-4.
  • 10 Watanabe Y, Nakazawa T, Yamada N, Higashi M, Hishikawa T, Miyamoto S, et al. Identification of the distal dural ring with use of fusion images with 3D-MR cisternography and MR angiography: Application to paraclinoid aneurysms. Am J Neuroradiol Apr 2009;30:845-50.
  • 11 Yoon SJ, Shin NY, Lee JW, Huh SK, Park KY. Localization and treatment of unruptured paraclinoid aneurysms: A proton density MRI-based study. J Cerebrovasc Endovasc Neurosurg 2015;17:180-4.
  • 12 Murayama Y, Sakurama K, Satoh K, Nagahiro S. Identification of the carotid artery dural ring by using three-dimensional computerized tomography angiography. Technical note. J Neurosurg 2001;95:533-6.
  • 13 Kyoshima K, Koike G, Hokama M, Toriyama T, Gibo H, Okudera H, et al. A classification of juxta-dural ring aneurysms with reference to surgical anatomy. J Clin Neurosci 1996;3:61-4.
  • 14 Kobayashi S, Kyoshima K, Gibo H, Hegde SA, Takemae T, Sugita K. Carotid cave aneurysms of the internal carotid artery. J Neurosurg 1989;70:216-21.