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Kawajiri S, Isozaki M, Komori O, Yamada S, Higashino Y, Yamauchi T, Akazawa A, Kidoguchi M, Yomo M, Kodera T, Arishma H, Awara K, Inatani M, Kikuta K. Visual Evoked Potential Can Predict Deterioration of Visual Function After Direct Clipping of Paraclinoid Aneurysm With Anterior Clinoidectomy. Neurosurgery 2023; 92:1276-1286. [PMID: 36757317 DOI: 10.1227/neu.0000000000002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/14/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The role of visual evoked potential (VEP) in direct clipping of the paraclinoid internal carotid artery (ICA) aneurysm remains uncertain. OBJECTIVE To examine whether intraoperative neuromonitoring with VEP can predict deterioration of visual function after direct clipping of the paraclinoid ICA aneurysm with anterior clinoidectomy. METHODS Among consecutive 274 patients with unruptured cerebral aneurysm, we enrolled 25 patients with paraclinoid ICA aneurysm treated by direct clipping after anterior clinoidectomy with intraoperative neuromonitoring with VEP in this study. We evaluated the visual acuity loss (VAL) and visual field loss (VFL) before surgery, 1 month after surgery, and at the final follow-up. RESULTS The VAL at 1 month after surgery (VAL1M) and VAL at the final follow-up (Final VAL) were significantly related to the reduction rate of VEP amplitude at the end of surgery (RedEnd%), more than 76.5%, and the maximal reduction rate of VEP amplitude during surgery (MaxRed%), more than 66.7% to 70%. The VFL at 1 month after surgery (VFL1M) and the VFL at the final follow-up (Final VFL) were significantly related to MaxRed% more than 60.7%. CONCLUSION VAL1M, Final VAL, VFL1M, and Final VFL could be significantly predicted by the value of RedEnd% and MaxRed% in direct clipping of Al-Rodhan group Ia, Ib, and II paraclinoid ICA aneurysms with anterior clinoidectomy.
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Affiliation(s)
- Satoshi Kawajiri
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Tokyo, Japan
| | - Shinsuke Yamada
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yorhifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ayumi Akazawa
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamune Kidoguchi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Munetaka Yomo
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Toshiaki Kodera
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hidetaka Arishma
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kousuke Awara
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Kikkawa Y, Kurita H. Management of Wide-Necked Basilar tip Aneurysms. Adv Tech Stand Neurosurg 2022; 44:297-307. [PMID: 35107687 DOI: 10.1007/978-3-030-87649-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the frequency of direct surgery for basilar tip aneurysms is decreasing, the need for safe and effective surgical treatments for difficult-to-treat aneurysms, including large or wide-necked aneurysms, is likely to continue. In this chapter, our surgical approach for large wide-necked basilar tip aneurysms using the orbitozygomatic approach, the anterior temporal approach, and hybrid surgery are described.
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Affiliation(s)
- Yuichiro Kikkawa
- Department of Neurosurgery, Saitama Cardiovascular Respiratory Center, Kumagaya, Japan.
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Niibo T, Takizawa K, Sakurai J, Takebayashi S, Koizumi H, Kobayashi T, Kobayashi R, Kuris K, Gotou S, Tsuchiya R, Kamiyama H. Impact of Anterior Clinoidectomy on Visual Function After Paraclinoid Carotid Artery Aneurysm Surgery: Power-Drill Versus No-Drill Technique. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT
BACKGROUND
Few studies have attempted to make a direct comparison of the risk of visual impairment following extradural anterior clinoidectomy (EAC) with and without the use of a power drill.
OBJECTIVE
To evaluate postoperative visual outcomes between groups of patients with paraclinoid carotid artery aneurysms (PCAAs) who underwent surgical clipping with and without the use of a power drill during EAC.
METHODS
Between January 2010 and November 2019, 90 patients, 7 with ruptured and 83 with unruptured PCAAs, underwent clipping surgery at our hospital. The authors retrospectively analyzed postoperative visual complications from the medical records of these patients.
RESULTS
Among the 85 patients (excluding 3 patients with disturbance of consciousness caused by subarachnoid hemorrhage and 2 patients with preoperative visual disturbance) evaluated, EAC was conducted using a power drill in 64 patients and using a microrongeur in 21 patients. Permanent postoperative visual impairment developed in 14 (21.9%) patients in the drill group: 9 patients had ipsilateral lower nasal quadrant hemianopsia (ILNQH) and 5 patients had ipsilateral visual acuity reduction. Transient ILNQH developed in only 1 patient in the no-drill group. The incidence of permanent postoperative visual impairments was significantly lower in the no-drill group than in the drill group (P = .020). Seventeen (26.6%) patients developed transient oculomotor nerve palsy in the drill group, while no patients developed oculomotor nerve palsy in the no-drill group.
CONCLUSION
EAC using a microrongeur versus a power drill significantly improved visual outcomes after clipping surgery for PCAAs.
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Affiliation(s)
- Takeya Niibo
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Katsumi Takizawa
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Jurou Sakurai
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Seizi Takebayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Koizumi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Toru Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Rina Kobayashi
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Kouta Kuris
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Syusuke Gotou
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Ryousuke Tsuchiya
- Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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