J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600534
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical Relationships between Internal Carotid-Posterior Communicating Artery Aneurysms and Skull Base

Satoshi Matsuo
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
,
Noritaka Komune
2   Department of Otolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
,
So Takagishi
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
,
Kenichi Matsumoto
3   Department of Neurosurgery, Saga Medical Center Koseikan, Saga, Japan
,
Sei Haga
4   Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan
,
Takuya Inoue
1   Department of Neurosurgery, Kyushu Central Hospital, Fukuoka, Japan
,
Albert L. Rhoton
5   Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

Background: Proximally located internal carotid-posterior communicating artery (IC-PC) aneurysms can be closely related to the skull base structures such as the anterior clinoid process and anterior petroclinoid ligament, and it makes the microsurgical clipping of the aneurysms complicated.

Objective: To examine the microsurgical anatomy of the IC-PC aneurysm and surrounding skull base structures. This study also examined the clinical findings of the IC-PC aneurysms that require resecting the anterior clinoid process and anterior petroclinoid ligament.

Methods: The surgical anatomy surrounding the parasellar region was examined in a dry skull and 3 formalin-fixed human cadaveric heads in which the vessels were injected with colored silicone. The clinical, imaging, and microsurgical findings of 37 patients with 39 IC-PC aneurysms, who were treated microsurgically between April 2008 and July 2016, were retrospectively reviewed.

Result: The origin of the posterior communicating artery (PComA) from the internal carotid artery was exposed anatomically in the superior and lateral views of the parasellar region. Among the 39 IC-PC aneurysms, a partial anterior clinoidectomy was performed on 4 aneurysms (10.3%) and a partial resection of the anterior petroclinoid ligament was performed on 2 aneurysms (5.1%) to expose the proximal neck. No permanent operative complications were encountered in any patients after both procedures. Multi-angled microsurgical and intraoperative images show the relationships between the origin of the PComA and adjacent skull base structures in the parasellar region.

Conclusion: Proximally located IC-PC aneurysms have close relationships with the anterior clinoid process and anterior petroclinoid ligament, which occasionally needed to be resected to improve the visualization of the proximal neck of the aneurysm. Precise understanding of the anatomical relationship between the IC–PC aneurysms and skull base structures makes the surgery more accurate and safe.