title: Contralateral Approach to Internal Carotid Artery Ophthalmic Segment Aneurysms: Angiographic Analysis and Surgical Results for 30 Patients.
abstract: BACKGROUND
  Contralateral aneurysm clipping can be applied to bilateral intracranial aneurysms of the anterior circulation and to selected aneurysms on the medial wall of the internal carotid artery (ICA).
  
  
  OBJECTIVE
  To identify anatomic and radiological parameters that would favor a contralateral microsurgical approach to ICA-ophthalmic segment (ICA-opht) aneurysms.
  
  
  METHODS
  For the period January 1957 to December 2012, we retrospectively analyzed 268 patients with ICA-opht aneurysms treated in our institution. Of these patients, 30 underwent a contralateral approach; 15 patients (50%) had multiple intracranial aneurysms, and 15 patients had a single aneurysm on the contralateral side of the craniotomy.
  
  
  RESULTS
  Thirty saccular aneurysms located on the contralateral ICA were treated. Six aneurysms (20%) were present in patients with a subarachnoid hemorrhage due to associated aneurysms, whereas 24 aneurysms (80%) had no history of bleeding. Contralateral aneurysms were smaller than 14 mm and showed no wall irregularities, calcifications, or secondary pouches. Projections of the aneurysms were superomedial (n = 23, 77%), medial (n = 4, 13%), and superior (n = 3, 10%). The median prechiasmatic distance was 5.7 mm (range, 3.4-8.7 mm), the median interoptic distance was 10.5 mm (range, 7.6-15.9 mm), and the median distance between both ICAs was 14.7 mm (range, 10.4-21.4 mm).
  
  
  CONCLUSIONS
  The contralateral approach for ICA-opht aneurysms remains a treatment option for intracranial aneurysms. Its feasibility depends on specific anatomic parameters related to the aneurysm itself and to the prechiasmatic distance, interoptic distance, and relationship of the ICA with the anterior clinoid process.
authors: *Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; ‡Department of Biosciences, University of Helsinki, Helsinki, Finland; §Department of Neurosurgery, NeuroCenter, Kuopio University Central Hospital, Kuopio Finland.
authors: Hugo
authors: H
authors: Andrade-Barazarte
authors: Juri
authors: J
authors: Kivelev
authors: Felix
authors: F
authors: Goehre
authors: Behnam Rezai
authors: BR
authors: Jahromi
authors: Ferzat
authors: F
authors: Hijazy
authors: Nicolas
authors: N
authors: Moliz
authors: Adrien
authors: A
authors: Gauthier
authors: Riku
authors: R
authors: Kivisaari
authors: Juha E
authors: JE
authors: Jääskeläinen
authors: Hanna
authors: H
authors: Lehto
authors: Juha A
authors: JA
authors: Hernesniemi
mesh_terms: D000328:Adult; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009880:Ophthalmic Artery / Q000601:surgery*; D012189:Retrospective Studies