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| Name | Microsurgical Clipping of a Superior Hypophyseal Artery Aneurysm |
| Video Uploader | Video From Barrow Neurological Institute |
| Upload Date | This Video Uploaded At 26-05-2020 23:17:06 |
| Video Discription | This superior hypophyseal artery aneurysm (SHA) was found incidentally. Her vision was intact. CT angiogram showed a 5 millimeter aneurysm on the left internal carotid artery (ICA) projecting medially into the sella. It was completely opposite of the tip of the anterior clinoid process and hugging the anterior wall of the sella. We began by removing the anterior clinoid process. The optic nerve was gently mobilized off of the optic strut. Fibrin glue was injected through the roof of the cavernous sinus for hemostasis. Dissection of the distal dural ring was performed by cutting into the optic canal, incising the distal dural ring along the lateral wall of the supraclinoid carotid artery, and then following it medially towards the carotid cave. The carotid artery, along with the aneurysm, were pulled away from the optic nerve. A 45-degree angled fenestrated clip was threaded under the supraclinoid segment and across the neck. As the medial blade was advanced, care was taken to work it underneath two small superior hypophyseal artery branches. It is important to preserve these vessels to maintain vision. Postoperative angiogram confirmed optimal clip placement. The patient did well and remained neurologically intact after surgery, including her vision and visual fields. In conclusion, superior hypophyseal artery aneurysms require anterior clinoidectomy and a near-complete circumferential dissection of the distal dural ring to pass the fenestrated clip blades. Dissection must direct the manipulation to the ICA and aneurysm rather than to the optic nerve. The medial blade must pass beneath the SHA branches which supply the optic apparatus. Visual complications must be carefully avoided with SHA aneurysms. Proximal control of the cervical ICA may be needed with ruptured aneurysms. |
| Category | Science & Technology |
| Tags | superior hypophyseal artery aneurysm clipping | superior hypophyseal artery aneurysm | surgery of the superior hypophyseal artery | skull base surgery | clinoidectomy | internal carotid artery aneurysm | internal carotid artery | aneurysm clipping | aneurysm surgery | microsurgical aneurysm clipping | cerebrovascular surgery | neurosurgery | neurosurgery video |
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