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Journal of Korean Neurosurgical Society > Volume 42(1); 2007 > Article
Journal of Korean Neurosurgical Society 2007;42(1): 35-41.
Determination of Aneurysmal Location with 3 Dimension-Computed Tomographic Angiography in the Microsurgery of Paraclinoid Aneurysms.
Min Young Kim, Seung Young Chung, Seung Min Kim, Moon Sun Park, Sung Sam Jung
Department of Neurosurgery, School of Medicine, Eulji University, Daejeon, Korea. neurocsy@eulji.ac.kr
Determining the location of paraclinoid aneurysms for microsurgery is important for selecting treatment options, especially when deciding on the release of the dural ring in direct clipping. We examined the reliability of using the optic strut as an anatomical landmark for evaluating the location of paraclinoid aneurysms.
Cadaveric dissection was performed to establish the relationship of the optic strut to the dural ring. Results from these anatomic studies were compared with the three-demensional computed tomographic angiographic (3D-CTA) findings of nine patients with ten paraclinoid aneurysms between May 2004 and October 2005. These, 3D-CTA results were then compared with intraoperative findings.
The inferior boundary of the optic strut accurately localized the point at the proximal dural ring in cadaveric study. The optic strut and its relationship to the aneurysms was well observed on the multiplanar reformats of 3D-CTA. During microsurgery, nine of ten aneurysms were verified to arise from distal to the upper surface of the optic strut. Two aneurysms that had arisen between the inferior and superior boundary of the optic strut were observed to lie within the carotid cave. One aneurysm which had arisen at the inferior boundary of the optic strut and directed inferiorly was observed to lie within the cavernous sinus just after the release of the proximal ring.
The optic strut, as identified with multiplanar reformats of 3D-CTA, provided a reliable anatomic landmark for the proximal rings and an important information about the location of aneurysms around the anterior clinoid process (ACP). Therefore, 3D-CTA and the optic strut could become an invaluable tool and a landmark in the assessment of the location of paraclinoid aneurysms for microsurgery.
Key Words: Optic strut; Dural ring; Three-dimensional computed tomographic angiography; Paraclinoid aneurysms
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