Management of an Uncommon Complication: Anterior Choroidal Artery Occlusion by Posterior Clinoid Process Detected Through Intraoperative Monitoring After Clipping of Paraclinoid Aneurysm: 2-Dimensional Operative Video.
Walter MaraniFrancisco MannaráKosumo NodaTomomasa KondoNakao OtaPaolo PerriniNicola MontemurroYu KinoshitaShoichiro TsujiHiroyasu KamiyamaRokuya TanikawaPublished in: Operative neurosurgery (Hagerstown, Md.) (2021)
Despite technological advances in endovascular therapy, surgical clipping of paraclinoid aneurysms remains an indispensable treatment option and has an acceptable profile risk. Intraoperative monitoring of motor and somatosensory evoked potentials has proven to be an effective tool in predicting and preventing postoperative motor deficits during aneurysm clipping.1,2 We describe the case of a 61-yr-old Japanese woman with a history of hypertension and smoking. During follow-up for bilateral aneurysms of ophthalmic segment of the internal carotid artery (ICA), left-sided aneurysm growth was detected. A standard pterional approach with extradural clinoidectomy was used to approach the aneurysm. After clipping, a significant intraprocedural change in motor evoked potential (MEP) amplitude was observed despite native vessel patency was confirmed through micro-Doppler and indocyanine green video angiography.3-5 After extensive dissection of the sylvian fissure and exposure of the communicating segment of ICA, the anterior choroidal artery was found to be compressed and occluded by the posterior clinoid because of an inadvertent shift of the ICA after clip application and removal of brain retractors. Posterior clinoidectomy was performed intradurally with microrongeur and MEP amplitude returned readily to baseline values. Computed tomography (CT) angiogram demonstrated complete exclusion of the aneurysm, and magnetic resonance imaging (MRI) was negative for postoperative ischemic lesions on diffusion weighted images. The patient tolerated the procedure well and was discharged home on postoperative day 3 with modified Rankin Scale (mRS) 0. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
Keyphrases
- internal carotid artery
- contrast enhanced
- computed tomography
- optical coherence tomography
- coronary artery
- magnetic resonance imaging
- diffusion weighted
- patients undergoing
- case report
- middle cerebral artery
- abdominal aortic aneurysm
- positron emission tomography
- healthcare
- minimally invasive
- deep learning
- dual energy
- convolutional neural network
- traumatic brain injury
- resting state
- magnetic resonance
- diffusion weighted imaging
- stem cells
- image quality
- bone marrow
- risk assessment
- machine learning
- climate change
- blood brain barrier
- white matter
- cell therapy
- functional connectivity
- age related macular degeneration
- mesenchymal stem cells
- combination therapy