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J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e255-e260
DOI: 10.1055/s-0033-1349336
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Is It Safe to Sacrifice the Superior Hypophyseal Artery in Aneurysm Clipping? A Report of Two Cases

Ehab Ahmed El Refaee
1   Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
2   Department of Neurosurgery, Kasr Al Ainy, El Manial Hospital, Cairo University, Cairo, Egypt
,
Jörg Baldauf
1   Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
,
Valentin Balau
3   Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
,
Christian Rosenstengel
1   Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
,
Henry Schroeder
1   Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
› Author Affiliations
Further Information

Publication History

20 September 2012

22 March 2013

Publication Date:
03 August 2013 (online)

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Abstract

Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. However, consequences of SHA sacrifice are rarely reported in the literature. In the two presented cases, the SHA was found originating distal to the neck and within the wall of the aneurysm, making the optimal clipping of the aneurysm at the neck unfeasible without trapping of the SHA. Intraoperative indocyanine green (ICG) angiography revealed a retrograde blood flow in the SHA distal to the clip in both patients, indicating some collateral circulation. No endocrinologic deficits were encountered after surgery. The vision was not affected in one patient. In the other patient, bilateral visual field defects occurred, which improved partially in the follow-up 2 months after surgery. The consequences of SHA occlusion are difficult to predict. A large variety of anatomical variations of the vascular anatomy exists. Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.

Keywords

superior hypophyseal artery aneurysm - superior hypophyseal artery sacrifice - aneurysm clipping - collateral blood flow
 

  • References

  • 1 Day AL. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 1990; 72 (5) 677-691
    CrossrefPubMedGoogle Scholar
  • 2 Krisht AF, Barrow DL, Barnett DW, Bonner GD, Shengalaia G. The microsurgical anatomy of the superior hypophyseal artery. Neurosurgery 1994; 35 (5) 899-903 , discussion 903
    CrossrefPubMedGoogle Scholar
  • 3 Bradac GB. Carotid artery anatomy in cerebral angiography. Cereberal Angiography Normal Anatomy and Vascular Pathology. Berlin, Heidelberg: Springer-Verlag; 2011: 5-19
    Google Scholar
  • 4 Goto T, Tanaka Y, Kodama K, Kusano Y, Sakai K, Hongo K. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report. J Neurosurg 2007; 107 (4) 865-867
    CrossrefPubMedGoogle Scholar
  • 5 Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS. Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 2001; 48 (1) 78-89 , discussion 89–90
    PubMedGoogle Scholar
  • 6 McDougall CG, Spetzler RF, Zabramski JM , et al. The Barrow Ruptured Aneurysm Trial. J Neurosurg 2012; 116 (1) 135-144
    CrossrefPubMedGoogle Scholar
  • 7 Molyneux A, Kerr R, Stratton I , et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360 (9342) 1267-1274
    CrossrefPubMedGoogle Scholar
  • 8 Pereira-Filho AA, Pereira AG, Faria MB, Lima LC, Portuguez MW, Kraemer JL. Microsurgical clipping in forty patients with unruptured anterior cerebral circulation aneurysms: an investigation into cognitive outcome. Arq Neuropsiquiatr 2010; 68 (5) 770-774
    CrossrefPubMedGoogle Scholar
  • 9 Kakizawa Y, Tanaka Y, Orz Y, Iwashita T, Hongo K, Kobayashi S. Parameters for contralateral approach to ophthalmic segment aneurysms of the internal carotid artery. Neurosurgery 2000; 47 (5) 1130-1136 , discussion 1136–1137
    CrossrefPubMedGoogle Scholar
  • 10 Tomoichiro K, Tamotsu F, Tatsuya Y. Two Cases of Superior Hypophyseal Artery Aneurysm Clipped Through Contralateral Pterional Approach. Surgery for Cerebral Stroke 2002; 30 (1) 52-56
    CrossrefPubMedGoogle Scholar
  • 11 Chen S, Kato Y, Kumar A , et al. Contralateral approach to unruptured superior hypophyseal artery aneurysms. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (1) 18-24
    PubMedGoogle Scholar
  • 12 Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery 1998; 42 (2) 226-231 , discussion 231–232
    CrossrefPubMedGoogle Scholar
  • 13 Kinouchi H, Futawatari K, Mizoi K, Higashiyama N, Kojima H, Sakamoto T. Endoscope-assisted clipping of a superior hypophyseal artery aneurysm without removal of the anterior clinoid process. Case report. J Neurosurg 2002; 96 (4) 788-791
    CrossrefPubMedGoogle Scholar
  • 14 Yapor WY, Crowell RM. Superior hypophyseal artery aneurysm. Report of two cases. J Neurosurg 1991; 74 (3) 501-503
    CrossrefPubMedGoogle Scholar
  • 15 Giannotta SL. Ophthalmic segment aneurysm surgery. Neurosurgery 2002; 50 (3) 558-562
    PubMedGoogle Scholar
  • 16 Nanda A, Javalkar V. Microneurosurgical management of ophthalmic segment of the internal carotid artery aneurysms: single-surgeon operative experience from Louisiana State University, Shreveport. Neurosurgery 2011; 68 (2) 355-370 , discussion 370–371
    CrossrefPubMedGoogle Scholar
  • 17 Ferrell AS, Lessne ML, Alexander MJ , et al. Visual complications after stent-assisted endovascular embolization of paraophthalmic and suprasellar variant superior hypophyseal aneurysms: the Duke Cerebrovascular Center experience in 57 patients. World Neurosurg 2012; 78 (3-4) 289-294
    CrossrefPubMedGoogle Scholar
  • 18 Marinković SV, Milisavljević MM, Marinković ZD. Microanatomy and possible clinical significance of anastomoses among hypothalamic arteries. Stroke 1989; 20 (10) 1341-1352
    CrossrefPubMedGoogle Scholar
  • 19 Rhoton Jr AL. The supratentorial arteries. Neurosurgery 2002; 51 (4, Suppl): S53-S120
    PubMedGoogle Scholar
  • 20 Osborn AG, Jacobs JM. Diagnostic Cerebral Angiography. Philadelphia: Lippincott Williams & Wilkins; 1999: 97
    Google Scholar
  • 21 de Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A. Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 2008; 62 (6) (Suppl. 03) 1300-1310
    PubMedGoogle Scholar
  • 22 Cedzich C, Schramm J, Fahlbusch R. Are flash-evoked visual potentials useful for intraoperative monitoring of visual pathway function?. Neurosurgery 1987; 21 (5) 709-715
    CrossrefPubMedGoogle Scholar
  • 23 Wiedemayer H, Fauser B, Armbruster W, Gasser T, Stolke D. Visual evoked potentials for intraoperative neurophysiologic monitoring using total intravenous anesthesia. J Neurosurg Anesthesiol 2003; 15 (1) 19-24
    CrossrefPubMedGoogle Scholar