Summary
During the last 10 years, we had to resect the anterior clinoid process (ACP) before applying the clip in three of the 70 patients with internal carotid-posterior communicating artery (ICPCom) aneurysms. To reveal the angiographic characteristics in these three patients, we measured the following parameters on carotid angiograms in all 70 patients: 1) the angle between the midline of the skull and the axis of the C 1 segment of the internal carotid artery (ICA) on A-P view (angle A), 2) the angle between the axes of the C1 and C2 segments of the ICA on A-P view (angle B), and 3) the distance between the posterior wall of the carotid “knee” and the proximal aneurysmal neck on lateral view (distance d). The common angiographic features of these three patients were as follows: 1) angle A was larger than 60 degrees, 2) angle B was less than 90 degrees, 3) distance d was less than 10mm, and 4) the posterior communicating artery was of the foetal type.
The present results suggest that preoperative angiogram can predict whether or not the ACP should be removed during ICPCom aneurysm surgery.
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References
Chrzanowski R (1971) The assessment of the intracranial part of the internal carotid artery. Neuroradiol 2: 223–226
Fox JL (1983) Intracranial aneurysms, Vol 2. Springer, New York Berlin Heidelberg Tokyo, pp 800–811
Guidetti B, La Torre E (1975) Management of carotid-ophthalmic aneurysms. J Neurosurg 42: 438–442
Iwabuchi T, Suzuki Sh, Sobata E (1978) Intracranial direct operation for carotid-ophthalmic aneurysm by unroofing of the optic canal. Acta Neurochir (Wien) 43: 163–169
Morgan F (1972) Removal of anterior clinoid process in the surgery of carotid aneurysms. With some notes on recurrent subarachnoid haemorrhage during craniotomy. Schweiz Arch Neurol Neurochir Psychiatry 111: 363–368
Nutik S (1978) Carotid paraclinoid aneurysms with intradural origin and intracavernous location. J Neurosurg 48: 526–533
Sano K (1979) Internal carotid-posterior communicating-anterior choroidal region aneurysms. Microsurgical treatment. In: Pia HW, Langmaid C, Zierski J (eds) Cerebral aneurysms. Advances in diagnosis and therapy. Springer, Berlin Heidelberg New York, pp 252–259
Sengupta RP, Gryspeerdt GL, Hankinson J (1976) Carotid-ophthalmic aneurysms. J Neurol Neurosurg Psychiatry 39: 837–853
Sundt TM, Piepgras DG (1979) Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. J Neurosurg 51: 731–742
VanderArk GD, Kempe LG, Kobrine A (1972) Classification of internal carotid aneurysms as a basis for surgical approach. Neurochirurgia (Stuttgart) 15: 81–85
Yaşargil MG, Gasser JC, Hodosh RM, Rankin TV (1977) Carotid-ophthalmic aneurysms: Direct microsurgical approach. Surg Neurol 8: 155–165
Yaşargil MG (1984) Microneurosurgery, Vol 2. Thieme, Stuttgart New York, pp 71–98
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Ochiai, C., Wakai, S., Inou, S. et al. Preoperative angiographical prediction of the necessity to removal of the anterior clinoid process in internal carotid-posterior communicating artery aneurysm surgery. Acta neurochir 99, 117–121 (1989). https://doi.org/10.1007/BF01402319
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DOI: https://doi.org/10.1007/BF01402319