Optic Foraminotomy for Clipping of Superior Carotid-Ophthalmic Aneurysms
Por:
Baldoncini, M, Luzzi, S, Lucifero, A, Flores-Justa, A, Gonzalez-Lopez, P, Campero, A, Villalonga, J and Lawton, M
Publicada:
9 dic 2021
Ahead of Print:
9 dic 2021
Resumen:
Background: Carotid-ophthalmic aneurysms usually cause visual problems. Its surgical treatment is challenging because of its anatomically close relations to the optic nerve, carotid artery, ophthalmic artery, anterior clinoid process, and cavernous sinus, which hinder direct access. Despite recent technical advancements enabling risk reduction of this complication, postoperative deterioration of visual function remains a significant problem. Therefore, the goal of preserving and/or improving the visual outcome persists as a paramount concern.Objective: We propose optic foraminotomy as an alternative microsurgical technique for dorsal carotid-ophthalmic aneurysms clipping. As a secondary objective, the step by step of that technique and its benefits are compared to the current approach of anterior clinoidectomy.Methods: We present as an example two patients with superior carotid-ophthalmic aneurysms in which the standard pterional craniotomy, transsylvian approach, and optic foraminotomy were performed. Surgical techniques are presented and discussed in detail with the use of skull base dissections, microsurgical images, and original drawings.Results: Extensive opening of the optic canal and optic nerve sheath was successfully achieved in all patients allowing a working angle with the carotid artery for correct visualization of the aneurysm and further clipping. Significant visual acuity improvement occurred in both patients because of decompression of the optic nerve.Conclusion: Optic foraminotomy is an easy and recommended technique for exposing and treating superior carotid-ophthalmic aneurysms and allowing optic nerve decompression during the first stages of the procedure. It shows several advantages over the current anterior clinoidectomy technique regarding surgical exposure and facilitating visual improvement.
Filiaciones:
Baldoncini, M:
San Fernando Hosp, Dept Neurol Surg, Buenos Aires, DF, Argentina
Univ Buenos Aires, Sch Med, Lab Microsurg Neuroanat, Chair Gross Anat 2, Buenos Aires, DF, Argentina
Luzzi, S:
Univ Pavia, Dept Clin Surg Diagnost & Pediat Sci, Neurosurgery Unit, Pavia, Italy
Fdn IRCCS Policlin San Matteo, Dept Surg Sci, Neurosurg Unit, Pavia, Italy
Lucifero, A:
Univ Pavia, Dept Clin Surg Diagnost & Pediat Sci, Neurosurgery Unit, Pavia, Italy
Flores-Justa, A:
Hosp Gen Univ Alicante, Dept Neurosurg, Alicante, Spain
:
Hosp Gen Univ Alicante, Dept Neurosurg, Alicante, Spain
Campero, A:
Padilla Hosp, Dept Neurol Surg, San Miguel De Tucuman, Argentina
Villalonga, J:
Padilla Hosp, Dept Neurol Surg, San Miguel De Tucuman, Argentina
Lawton, M:
Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA
gold, Green Published
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