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Distinction between paraclinoid and cavernous sinus aneurysms with computed tomographic angiography.
L Fernando Gonzalez1, Matthew T Walker, Joseph M Zabramski
1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery
|April 18, 2003
Summary
The optic strut is a reliable landmark on CT angiography for distinguishing between intradural and extradural aneurysms of the internal carotid artery (ICA). This anatomical marker helps surgeons accurately identify and treat these paraclinoid segment aneurysms.
Area of Science:
- Neurosurgery
- Radiology
- Anatomy
Background:
- Paraclinoid segment internal carotid artery (ICA) aneurysms present diagnostic challenges.
- Differentiating between intradural and extradural (cavernous sinus) aneurysms is crucial for surgical planning.
Purpose of the Study:
- To evaluate the reliability of the optic strut as an anatomical landmark.
- To differentiate between intradural and extradural aneurysms using computed tomographic (CT) angiography.
Main Methods:
- Microanatomic dissections of five cadaveric heads (10 sides) were performed.
- Relationships between the optic strut, cavernous sinus, and ICA were established.
- Anatomic findings were correlated with CT angiographic and intraoperative data from four patients with nine aneurysms.
Main Results:
- The inferior optic strut accurately indicated where the ICA exited the cavernous sinus.
- The optic strut was clearly visualized on CT angiography.
- Aneurysms distal to the strut were intradural (6/6 clipped successfully); aneurysms proximal were extradural (within the cavernous sinus).
Conclusions:
- The optic strut is a dependable landmark on CT angiography.
- It allows for accurate differentiation of intradural and extradural aneurysms involving the paraclinoid ICA segment.