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Authors: Serrano Sponton, Lucas Ezequiel
Title: Effectiveness of ipsi- and contralateral approaches to the ophthalmic segment of the internal carotid artery : a comparative morphometrical characterization in anatomic specimens and 3D- virtual surgical simulations=Effektivität von ipsi- und kontralateralen Zugängen zum ophthalmischen Abschnitt der Arteria carotis interna : eine komparative morphometrische Charakterisierung in anatomischen Präparaten und 3D-virtuelle chirurgische Simulationen
Online publication date: 20-Jan-2020
Year of first publication: 2020
Language: english
Abstract: Background Medially pointing aneurysms of the internal carotid artery’s ophthalmic segment (oICA) represent a neurosurgical challenge. Conventional ipsilateral approaches require ICA and optic nerve (ON) mobilization as well as anterior clinoidectomy (AC), all associated with increased surgical risk. Contralateral approaches could provide a better exposure of oICA’s superomedial aspect, ophthalmic artery (OA) and superior hypophyseal artery (SHA) sparing AC and ICA or ON mobilization. However, the microsurgical anatomy of this approach has not been systematically studied yet. In the present work we exhaustibly analysed the anatomical and morphometric characteristics of contralateral approaches to the oICA and compared them with those from ipsilateral approaches. Methods We assessed 36 ipsi- and contralateral approaches to the oICAs in cadaveric specimens and alive subjects, using for the last a 3D- virtual reality (VR) system. Results Contralateral approaches spared Sylvian fissure dissection and required only minimal frontal lobe retraction. The ipsilateral and contralateral oICA were found at a depth of 49.2±1.8mm (VR: 50.1±2.92mm) and 65.1±1.5mm (VR: 66.05±3.364mm) respectively. The exposure of the superomedial aspect of oICA was 7.25±0.86mm (VR: 6±1mm) contralaterally without ON mobilization and 2.44±0.51mm (VR: 2±1mm) ipsilaterally even after AC. Statistical analysis demonstrated that, for not prefixed chiasm, contralateral approaches achieved a significantly higher exposure of OA, SHA and oICA’s superomedial aspect with its perforating branches (all p<0.01). Conclusion Contralateral approaches may enable a successful exposure of the oICA and related vascular structures, reducing the need of AC or ON mobilization. Systematic clinical/surgical studies are needed to further determine approach’s effectiveness and safety.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
URN: urn:nbn:de:hebis:77-diss-1000032623
Version: Original work
Publication type: Dissertation
License: In Copyright
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Extent: 107 Blätter
Appears in collections:JGU-Publikationen

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