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A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms

  • Lucas Ezequiel Serrano
  • Ali Ayyad
  • Eleftherios Archavlis
  • Eike Schwandt
  • Amr Nimer
  • Florian Ringel
  • Sven Rainer Kantelhardt
ORIGINAL ARTICLE
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Abstract

Ipsilateral approaches remain the standard technique for clipping paraclinoid aneurysms. Surgeons must however be prepared to deal with bony and neural structures restricting accessibility. The application of a contralateral approach has been proposed claiming that some structures in the region can be better exposed from this side. Yet, only few case series have been published evaluating this approach, and there is a lack of systematic reviews assessing its specific advantages and disadvantages. We performed a structured literature search and identified 19 relevant publications summarizing 138 paraclinoid aneurysms operated via a contralateral approach. Patient’s age ranged from 19 to 79 years. Aneurysm size mainly varied between 2 and 10 mm and only three articles reported larger aneurysms. Most aneurysms were located at the origin of the ophthalmic artery, followed by the superior hypophyseal artery and carotid cave. All aneurysm protruded from the medial aspect of the carotid artery. Interestingly, minimal or even no optic nerve mobilization was required during exposure from the contralateral side. Strategies to achieve proximal control of the carotid artery were balloon occlusion and clinoid segment or cervical carotid exposure. Successful aneurysm occlusion was achieved in 135 cases, while 3 ophthalmic aneurysms had to be wrapped only. Complications including visual deterioration, CSF fistula, wound infection, vasospasm, artery dissection, infarction, and anosmia occurred in a low percentage of cases. We conclude that a contralateral approach can be effective and should be considered for clipping carefully selected cases of unruptured aneurysms arising from medial aspects of the above listed vessels.

Keywords

Contralateral approach Paraclinoid aneurysm 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical committee approval was not required as presented data corresponds to a review of published literature. The data corresponding to our exemplary surgical case (see “Discussion”) are anonymized, and there is no risk of identification.

Informed consent

Consent was not obtained given that presented data corresponding to our exemplary surgical case (see “Discussion”) are anonymized and there is no risk of identification.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryMainz University HospitalMainzGermany
  2. 2.Department of Neurosurgery, Charing Cross HospitalImperial College HealthcareLondonUK

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