Download PDF
J Neurol Surg B Skull Base 2022; 83(05): 505-514
DOI: 10.1055/s-0041-1730351
Original Article

Direct Clipping of Paraclinoid Aneurysm in Conjunction with Extradural Anterior Clinoidectomy: Technical Nuance and Functional Outcome

Sho Tsunoda 
1   Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
,
Tomohiro Inoue
1   Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
,
Naoko Takeuchi
2   Department of Rehabilitation, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
,
Atsuya Akabane
1   Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
,
Nobuhito Saito
3   Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Because of their anatomical features, treatment for paraclinoid aneurysms has remained to be challenging. Thus, the aim of this report is to prove the validity of our surgical method for unruptured paraclinoid aneurysms, together with surgical videos.

Study Design Between August 2017 and November 2019, we were able to perform surgical clipping for 11 patients with unruptured paraclinoid aneurysm using a completely unified method. This study investigated the effect of surgery on multiple measures, including visual impairment, brain contusion, temporalis muscle atrophy, and multiple neurocognitive functions.

Results Of the 67 unruptured aneurysms treated at our hospital, 17 were identified to be paraclinoid aneurysm, and 11 of them were treated by direct clipping using anterior clinoidectomy. Three were ophthalmic artery aneurysms, three were superior hypophyseal artery aneurysms, and five were anterior carotid wall aneurysms without branch projection. Only one patient had asymptomatic mild enlargement of the Marriott blind spots postoperatively. No brain contusion and temporalis muscle atrophy were observed in any cases. Only the Trail Making test (TMT) showed a significant worsening in the acute postoperative period: mean pre- and postoperative TMT scores were 59.1 ± 29.1 and 72.7 ± 37.3 for Part A (p = 0.018) and 80.5 ± 35.5 and 93.8 ± 39.9 for Part B (p = 0.030), respectively. However, it improved in the chronic phase.

Conclusion We can conclude that our surgical method is safe and can be considered an acceptable treatment. Although surgical stress can cause temporary executive dysfunction shortly after surgery, this decline is temporary.

Keywords

paraclinoid aneurysm - anterior clinoidectomy - neurocognitive function - temporalis muscle

Note

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee (NTT Medical Center Tokyo Ethical Committee, approval number: 19–194) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Informed Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Received: 02 June 2020

Accepted: 07 January 2021

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Asaid M, O'Neill AH, Bervini D, Chandra RV, Lai LT. Unruptured paraclinoid aneurysm treatment effects on visual function: systematic review and meta-analysis. World Neurosurg 2017; 106: 322-330
    CrossrefPubMedGoogle Scholar
  • 2 Matano F, Tanikawa R, Kamiyama H. et al. Surgical treatment of 127 paraclinoid aneurysms with multifarious strategy: factors related with outcome. World Neurosurg 2016; 85: 169-176
    CrossrefPubMedGoogle Scholar
  • 3 Nonaka T, Haraguchi K, Baba T, Koyanagi I, Houkin K. Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms. Surg Neurol 2007; 67 (06) 612-619 , discussion 619
    CrossrefPubMedGoogle Scholar
  • 4 Lee S-Y, Chae K-S, Rho S-J, Choi H-K, Park H-S, Ghang C-G. Clinical and angiographic outcomes of wide-necked aneurysms treated with the solitaire AB stent. J Cerebrovasc Endovasc Neurosurg 2013; 15 (03) 158-163
    CrossrefPubMedGoogle Scholar
  • 5 Wang Y, Li Y, Jiang C. et al. Endovascular treatment of paraclinoid aneurysms: 142 aneurysms in one centre. J Neurointerv Surg 2013; 5 (06) 552-556
    CrossrefPubMedGoogle Scholar
  • 6 Morihiro S, Isao H. MMSE-J (Seishin jyoutai tanjikan kensa-nihongo ban)no datousei to shinraisei ni tsuite: a preliminary report. Jpn J Cognit Neurosci 2010; 12: 186-190
    PubMedGoogle Scholar
  • 7 Kugo A, Terada S, Ata T. et al. Japanese version of the frontal assessment battery for dementia. Psychiatry Res 2007; 153 (01) 69-75
    CrossrefPubMedGoogle Scholar
  • 8 Lezak MD, Howieson DB, Loring DW, Fischer JS. Neuropsychological Assessment. Oxford University Press; 2004
    Google Scholar
  • 9 Broshek DK, Barth JT. The Halstead-Reitan neuropsychological test battery. In: Neuropsychological Assessment in Clinical Practice: A Guide to Test Interpretation and Integration. Hoboken, NJ: John Wiley & Sons Inc; 2000: 223-262
    Google Scholar
  • 10 Kashima H. Chuui shougai to zentouyou sonshou. Jpn J Rihabil Med (Japan) 1995; 32 (05) 294-297
    PubMedGoogle Scholar
  • 11 Axelrod BN, Ryan JJ, Ward LC. Evaluation of seven-subtest short forms of the Wechsler Adult Intelligence Scale-III in a referred sample. Arch Clin Neuropsychol 2001; 16 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 12 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedGoogle Scholar
  • 13 Liu J, Xiang J, Zhang Y. et al. Morphologic and hemodynamic analysis of paraclinoid aneurysms: ruptured versus unruptured. J Neurointerv Surg 2014; 6 (09) 658-663
    CrossrefPubMedGoogle Scholar
  • 14 Oh SY, Lee KS, Kim BS, Shin YS. Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms. Clin Neurol Neurosurg 2015; 128: 72-77
    CrossrefPubMedGoogle Scholar
  • 15 Shigematsu T, Fujinaka T, Yoshimine T. et al; JR-NET Investigators. Endovascular therapy for asymptomatic unruptured intracranial aneurysms: JR-NET and JR-NET2 findings. Stroke 2013; 44 (10) 2735-2742
    CrossrefPubMedGoogle Scholar
  • 16 Boet R, Wong GKC, Poon WS, Lam JMK, Yu SCH. Aneurysm recurrence after treatment of paraclinoid/ophthalmic segment aneurysms—a treatment-modality assessment. Acta Neurochir (Wien) 2005; 147 (06) 611-616 , discussion 616
    CrossrefPubMedGoogle Scholar
  • 17 Iihara K, Murao K, Sakai N. et al. Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg 2003; 99 (02) 241-247
    CrossrefPubMedGoogle Scholar
  • 18 Colli BO, Carlotti Jr CG, Assirati Jr JA, Abud DG, Amato MCM, Dezena RA. Results of microsurgical treatment of paraclinoid carotid aneurysms. Neurosurg Rev 2013; 36 (01) 99-114 , discussion 114–115
    CrossrefPubMedGoogle Scholar
  • 19 Khan N, Yoshimura S, Roth P. et al. Conventional microsurgical treatment of paraclinoid aneurysms: state of the art with the use of the selective extradural anterior clinoidectomy SEAC. In: Yonekawa Y, Keller E, Sakurai Y, Tsukahara T. eds. New Trends of Surgery for Stroke and Its Perioperative Management. Vienna: Springer; 2005: 23-29
    Google Scholar
  • 20 Kadri PAS, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 2004; 100 (03) 517-522
    CrossrefPubMedGoogle Scholar
  • 21 Oikawa S, Mizuno M, Muraoka S, Kobayashi S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy. Technical note. J Neurosurg 1996; 84 (02) 297-299
    CrossrefPubMedGoogle Scholar
  • 22 Spetzler RF, Lee KS. Reconstruction of the temporalis muscle for the pterional craniotomy. Technical note. J Neurosurg 1990; 73 (04) 636-637
    CrossrefPubMedGoogle Scholar
  • 23 Hwang SW, Abozed MM, Antoniou AJ, Malek AM, Heilman CB. Postoperative temporalis muscle atrophy and the use of electrocautery: a volumetric MRI comparison. Skull Base 2010; 20 (05) 321-326
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Inoue T, Ohwaki K, Tamura A, Tsutsumi K, Saito I, Saito N. Subtle structural change demonstrated on T2-weighted images after clipping of unruptured intracranial aneurysm: negative effects on cognitive performance. J Neurosurg 2014; 120 (04) 937-944
    CrossrefPubMedGoogle Scholar
  • 25 Kotowski M, Naggara O, Darsaut TE. et al. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry 2013; 84 (01) 42-48
    CrossrefPubMedGoogle Scholar
  • 26 Otani N, Mori K, Wada K. et al. Limited indications for clipping surgery of paraclinoid aneurysm based on long-term visual morbidity. World Neurosurg 2020; 134: e153-e161
    CrossrefPubMedGoogle Scholar
  • 27 Bonares MJ, Egeto P, de Oliveira Manoel AL, Vesely KA, Macdonald RL, Schweizer TA. Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis. J Neurosurg 2016; 124 (03) 784-790
    CrossrefPubMedGoogle Scholar
  • 28 Royall DR. The FAB: a frontal assessment battery at bedside. Neurology 2001; 57 (03) 565-565
    CrossrefPubMedGoogle Scholar
  • 29 Hagenaars SP, Cox SR, Hill WD. et al; CHARGE consortium Cognitive Working Group. Genetic contributions to Trail Making Test performance in UK Biobank. Mol Psychiatry 2018; 23 (07) 1575-1583
    CrossrefPubMedGoogle Scholar
  • 30 Gathercole SE. Cognitive approaches to the development of short-term memory. Trends Cogn Sci 1999; 3 (11) 410-419
    CrossrefPubMedGoogle Scholar
  • 31 Baldo JV, Schwartz S, Wilkins D, Dronkers NF. Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping. J Int Neuropsychol Soc 2006; 12 (06) 896-900
    CrossrefPubMedGoogle Scholar
  • 32 Warkentin S, Risberg J, Nilsson A. et al. Cortical activity during speech production: a study of regional cerebral blood flow in normal subjects performing a word fluency task. Neuropsychiatry Neuropsychol Behav Neurol 1991; 4: 305-316
    PubMedGoogle Scholar