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Surgical Anatomy of the Paraclinoid Region: Lessons From Many Masters

Surgical Anatomy of the Paraclinoid Region: Lessons From Many Masters . Issam A. Awad, MD, MSc, FACS, MA (hon) Professor of Neurosurgery Northwestern University Evanston Northwestern Health Evanston, Illinois. The Paraclinoid Region: Fundamentals for Every Surgeon.
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Surgical Anatomy of the Paraclinoid Region: Lessons From Many Masters Issam A. Awad, MD, MSc, FACS, MA (hon)Professor of NeurosurgeryNorthwestern UniversityEvanston Northwestern HealthEvanston, IllinoisThe Paraclinoid Region:Fundamentals for Every Surgeon
  • The anatomic facts: Rhoton’s Canon
  • Implications for paraclinoid aneurysms
  • Implications for surgical approach
  • Maximalist versus minimalist strategies
  • A personal philosophy
  • The Anatomic Facts: Rhoton’s Canon
  • Segments of the internal carotid artery (ICA)
  • Unique anatomic features of the C5-6 segments of the ICA
  • The oculomotor triangle
  • Relations to the optic nerve
  • Anatomy as
  • the surgeon’s safeguardThe Anatomic Facts: Rhoton’s Canon
  • Segments of the ICA
  • Fisher
  • Berenstein and Lasjaunias
  • Bouthillier and van Loveren
  • The Anatomic Facts: Rhoton’s Canon
  • Unique anatomic features of the C5-6 segments of ICA
  • The Anatomic Facts: Rhoton’s Canon
  • Unique anatomic features of the C5-6 segments of ICA
  • Hemodynamic stresses
  • Imaging limitations
  • Dural relationships
  • Bony relationships
  • The subarachnoid space
  • The Anatomic Facts: Rhoton’s Canon
  • Unique anatomic features of the C5-6 segments of ICA
  • Hemodynamic stresses
  • Imaging limitations
  • Dural relationships
  • Bony relationships
  • The subarachnoid space
  • The Anatomic Facts: Rhoton’s Canon
  • Unique anatomic features of the C5-6 segments of ICA
  • Hemodynamic stresses
  • Imaging limitations
  • Dural relationships
  • Bony relationships
  • The subarachnoid space
  • Imaging The Paraclinoid RegionKobayashi: Cisternographic GuidanceGonzales, Zabramski and Spetzler: Optic Strut as ReferenceThe Anatomic Facts: Rhoton’s Canon
  • The oculomotor triangle
  • The interclinoid ligament
  • The tentorial edge (anterior petroclinoid ligament)
  • The posterior petroclinoid ligament
  • Relations to Cr. Ns. III, IV and VI
  • The Anatomic Facts: Rhoton’s Canon
  • The oculomotor triangle
  • The interclinoid ligament
  • The tentorial edge (anterior petroclinoid ligament)
  • The posterior petroclinoid ligament
  • Relations to Cr. Ns. III, IV and VI
  • The Anatomic Facts: Rhoton’s Canon
  • Relations to the optic nerve
  • The anterior clinoid process
  • The falciform ligament
  • The optic strut
  • The distal ring
  • The proximal ring
  • The Anatomic Facts: Rhoton’s Canon
  • Anatomy as the surgeon’s safeguard
  • Ease of approach
  • Vascular control
  • Maximize safety
  • Maximize exposure, maneuverability
  • Maximize effectiveness
  • Implications for Paraclinoid Aneurysms
  • The ophthalmic aneurysm
  • The superior hypophyseal aneurysm (extradural versus carotid cave)
  • The ventral paraclinoid aneurysm (transitional versus intradural)
  • Ophthalmic Aneurysm
  • Optic nerve canal decompression + clinoidectomy
  • Endovascular adjuncts
  • Proximal control
  • Suction decompression
  • Intraoperative angiography
  • Ophthalmic AneurysmOphthalmic AneurysmIO AngioIO AngioSuperior Hypophyseal AneurysmVentral Paraclinoid AneurysmVentral Paraclinoid AneurysmClip Intradural Portion, Coil Extradural PortionMaximalist vs. Minimalist Strategies
  • Adaptation of conventional approaches
  • Maximalist skull base approaches
  • Minimalist (keyhole, endoscopic assisted or controlled)
  • Focused strategies
  • A Personal Philosphy: Balancing What is “Safe”and What is “Feasible”
  • Proximal control
  • Intradural versus extradural consideration
  • Endovascular adjuncts
  • Endovascular treatments
  • Future challenges and opportunities -- surgical, endovascular
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