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Step-wise pterional combined epidural and subdural approach to clip large carotid-ophthalmic segment aneurysms

  • Peng HuEmail author
  • Hong-Qi Zhang
  • Xing-Juan Li
How I Do it - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery - Aneurysm

Abstract

Background

Microsurgical clipping of large ophthalmic-carotid artery (OA) aneurysms is technically challenging. Among the reported approaches, pterional combined epidural and subdural approach is one of the efficient choices.

Method

We have applied this approach to treat a 33-year old female patient with a left large OA aneurysm. The step-wise technical details of this approach are reported.

Conclusion

We show that it is a safe way to clip large OA aneurysms through a step-wise pterional combined epidural and subdural approach, which could make a clear anatomy and a confident manipulation.

Keywords

Ophthalmic-carotid artery aneurysm Large Clipping 

Abbreviations

CSF

Cerebrospinal fluid

CT

Computed tomography

ICA

Internal carotid artery

DSA

Digital subtracted angiography

MEP

Motor evoked potentials

MRI

Magnetic resonance imaging

OA

Ophthalmic-carotid artery

SEP

Somatosensory evoked potentials

Notes

Acknowledgements

The authors would like to thank Mr. Ming-Chu Li for his nice preparation of cadaveric anatomy pictures.

Funding information

Doctor Peng Hu was sponsored by the National Natural Science Foundation of China (grant number of 81500988). Doctor Peng Hu and Doctor Hong-Qi Zhang were sponsored by the National Key R&D Program of China (grant number 2016YFC1300800). The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been approved by the Local University Hospital Ethics Review Board (Xuanwu Hospital, Capital Medical University).

Informed consent

Written consent form has been obtained from each patient.

References

  1. 1.
    Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672CrossRefGoogle Scholar
  2. 2.
    Dolenc VV (1999) A combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain. Acta Neurochir Suppl 72:89–97Google Scholar
  3. 3.
    Hakuba A, Tanaka K, Suzuki T, Nishimura S (1989) A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 71:699–704CrossRefGoogle Scholar
  4. 4.
    Umansky F, Nathan H (1982) The lateral wall of the cavernous sinus. With special reference to the nerves related to it. J Neurosurg 56:228–234CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.XuanWu HospitalCapital Medical UniversityBeijingChina

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