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A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms

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Abstract

Ipsilateral approaches remain the standard technique for clipping paraclinoid aneurysms. Surgeons must however be prepared to deal with bony and neural structures restricting accessibility. The application of a contralateral approach has been proposed claiming that some structures in the region can be better exposed from this side. Yet, only few case series have been published evaluating this approach, and there is a lack of systematic reviews assessing its specific advantages and disadvantages. We performed a structured literature search and identified 19 relevant publications summarizing 138 paraclinoid aneurysms operated via a contralateral approach. Patient’s age ranged from 19 to 79 years. Aneurysm size mainly varied between 2 and 10 mm and only three articles reported larger aneurysms. Most aneurysms were located at the origin of the ophthalmic artery, followed by the superior hypophyseal artery and carotid cave. All aneurysm protruded from the medial aspect of the carotid artery. Interestingly, minimal or even no optic nerve mobilization was required during exposure from the contralateral side. Strategies to achieve proximal control of the carotid artery were balloon occlusion and clinoid segment or cervical carotid exposure. Successful aneurysm occlusion was achieved in 135 cases, while 3 ophthalmic aneurysms had to be wrapped only. Complications including visual deterioration, CSF fistula, wound infection, vasospasm, artery dissection, infarction, and anosmia occurred in a low percentage of cases. We conclude that a contralateral approach can be effective and should be considered for clipping carefully selected cases of unruptured aneurysms arising from medial aspects of the above listed vessels.

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Authors and Affiliations

  1. Department of Neurosurgery, Mainz University Hospital, Langenbeckstraße 1, 55131, Mainz, Germany

    Lucas Ezequiel Serrano, Ali Ayyad, Eleftherios Archavlis, Eike Schwandt, Florian Ringel & Sven Rainer Kantelhardt

  2. Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare, Fulham Palace Rd, London, W6 8RF, UK

    Amr Nimer

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  1. Lucas Ezequiel Serrano
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  2. Ali Ayyad
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  3. Eleftherios Archavlis
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Correspondence to Lucas Ezequiel Serrano.

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Ethical committee approval was not required as presented data corresponds to a review of published literature. The data corresponding to our exemplary surgical case (see “Discussion”) are anonymized, and there is no risk of identification.

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Consent was not obtained given that presented data corresponding to our exemplary surgical case (see “Discussion”) are anonymized and there is no risk of identification.

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Lucas Ezequiel Serrano and Ali Ayyad are joint first authors.

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Serrano, L.E., Ayyad, A., Archavlis, E. et al. A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms. Neurosurg Rev 42, 877–884 (2019). https://doi.org/10.1007/s10143-018-01063-3

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