A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms
- 50 Downloads
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.
KeywordsContralateral approach Paraclinoid aneurysm
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
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.
- 1.Alaa A-M, Bose G, Hunt K, Toma AK (2017) Adenosine-assisted neurovascular surgery: initial case series and review of literature. Neurosurg Rev 1–8Google Scholar
- 2.Andrade-Barazarte H, Kivelev J, Goehre F, Jahromi BR, Hijazy F, Moliz N, Gauthier A, Kivisaari R, Jaaskelainen JE, Lehto H, Hernesniemi JA (2015) Contralateral approach to internal carotid artery ophthalmic segment aneurysms: angiographic analysis and surgical results for 30 patients. Neurosurgery 77:104–112; discussion 112. https://doi.org/10.1227/NEU.0000000000000742 CrossRefGoogle Scholar
- 3.Blomqvist EH, Bramerson A, Stjarne P, Nordin S (2004) Consequences of olfactory loss and adopted coping strategies. Rhinology 42:189–194Google Scholar
- 4.Chandela S, Chakraborty S, Ghobrial GM, Jeddis A, Sen C, Langer DJ (2011) Contralateral mini-craniotomy for clipping of bilateral ophthalmic artery aneurysms using unilateral proximal carotid control and Sugita head frame. World Neurosurg 75:78–82; discussion 41–72. https://doi.org/10.1016/j.wneu.2010.06.028 CrossRefGoogle Scholar
- 7.Cho MJ, Oh CW, Kwon O-K, Byoun HS, Lee SU, Kim T, Chung YS, Ban SP, Bang JS (2017) Comparison of unilateral and bilateral craniotomy for the treatment of bilateral middle cerebral artery aneurysms: anatomic and clinical parameters and surgical outcomes. World neurosurgery 108:627–635CrossRefGoogle Scholar
- 8.Clatterbuck RE, Tamargo RJ (2005) Contralateral approaches to multiple cerebral aneurysms. Neurosurgery 57:160–163 discussion 160–163Google Scholar
- 15.Hongo K, Watanabe N, Matsushima N, Kobayashi S (2001) Contralateral pterional approach to a giant internal carotid-ophthalmic artery aneurysm: technical case report. Neurosurgery 48:955–959Google Scholar
- 32.Park J, Lee SH, Kang DH, Kim JS (2009) Olfactory dysfunction after ipsilateral and contralateral pterional approaches for cerebral aneurysms. Neurosurgery 65:727–732; discussion 732. https://doi.org/10.1227/01.NEU.0000350225.36099.0B CrossRefGoogle Scholar
- 33.Pereira RS, Casulari L (2006) Surgical treatment of bilateral multiple intracranial aneurysms: review of a personal experience in 69 cases. J Neurosurg Sci 50:1Google Scholar
- 41.Taniguchi M, Perneczky A (1997) Subtemporal keyhole approach to the suprasellar and petroclival region: microanatomic considerations and clinical application. Neurosurgery 41:592–601Google Scholar
- 49.Yaşargil MG (1984) Clinical considerations, surgery of the intracranial aneurysms and results, vol 2. ThiemeGoogle Scholar