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Neurosurgical Review

, Volume 37, Issue 4, pp 637–641 | Cite as

Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms

  • Erez Nossek
  • Avi Setton
  • Amir R. Dehdashti
  • David J. ChalifEmail author
Original Article

Abstract

Proximally located posterior communicating artery (PCoA) aneurysms, projecting postero-laterally in proximity to the tentorium, may pose a technical challenge for microsurgical clipping due to obscuration of the proximal aneurysmal neck by the anterior petroclinoid fold. We describe an efficacious technique utilizing fenestration of the anterior petroclinoid fold to facilitate visualization and clipping of PCoA aneurysms abutting this aspect of the tentorium. Of 86 cases of PCoA aneurysms treated between 2003 and 2013, the technique was used in nine (10.5 %) patients to allow for adequate clipping. A 3 mm fenestration in the anterior petroclinoid ligament is created adjacent and lateral to the anterior clinoid process. This fenestration is then widened into a small wedge corridor by bipolar coagulation. In all cases, the proximal aneurysm neck was visualized after the wedge fenestration. Additionally, an adequate corridor for placement of the proximal clip blade was uniformly established. All cases were adequately clipped, with complete occlusion of the aneurysm neck and fundus with preservation of the PCoA. There were two intraoperative ruptures not related to creation of the wedge fenestration. One patient experienced post-operative partial third nerve palsy, which resolved during follow-up. We describe a technique of fenestration of the anterior petroclinoid fold to establish a critical and safe corridor for both visualization and clipping of PCoA aneurysms.

Keywords

Brain aneurysm Petroclinoid fold Posterior communicating artery 

Abbreviations

PCoA

Posterior communicating artery

ICA

Internal carotid artery

Notes

Conflict of interest

None

Supplementary material

ESM 1

(M4V 8962 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Erez Nossek
    • 1
  • Avi Setton
    • 1
  • Amir R. Dehdashti
    • 1
  • David J. Chalif
    • 1
    • 2
    Email author
  1. 1.Department of NeurosurgeryHofstra North Shore–Long Island Jewish School of Medicine, and North Shore–Long Island Jewish Health SystemManhassetUSA
  2. 2.Department of Neurosurgery, North Shore–Long Island Jewish Health SystemNorth Shore University HospitalManhassetUSA

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