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Vol. 18. Issue 3.
Pages 201-208 (January 2007)
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Vol. 18. Issue 3.
Pages 201-208 (January 2007)
Clinoidectomía anterior intradural. Estudio anatomo-clínico y utilidad en el tratamiento de los aneurismas paraclinoideos trans-segmentarios C5-C6
Intradural anterior clinoidectomy. Anatmoclinical study and its usefulness in the tratatment of trans-segmentary C5-C6 trans-segmentary paraclinoid aneurysms
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J.M. González-Darder
Servicio de Neurocirugía. Hospital General de Castellón. Castellón de la Plana
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Resumen
Objetivo

Realizar un estudio anatomoclínico de la clinoidectomía anterior intradural y evaluar su utilidad en el tratamiento microquirúrgico de los aneurismas paraclinoideos. Presentar dos casos de un subtipo de aneurismas paraclinoideos, con el cuello y saco ocupando tanto el espacio clinoideo como el subaracnoideo (aneurismas paraclinoideos trans-segmentarios C5-C6).

Material y métodos

Se ha realizado un estudio microanatómico de la región clinoidea en cráneos secos y espécimenes fijados. Se describen los pasos de la clinoidectomía anterior y los elementos anatómicos que se pueden identificar. Se describen los hallazgos de imagen y quirúrgicos de dos casos de aneurismas paraclinoideos trans-segmentarios C5-C6.

Resultados

El segmento C5 o clinoideo de la carótida interna se convierte en intradural tras la clinoidectomía anterior intradural, con lo que se expone la transición de los segmentos C5 o clinoideo y el C6 u oftálmico, que se moviliza tras la sección del anillo distal de la carótida. Estas maniobras permiten la identificación microquirúrgica del cuello y saco de los aneurismas trans-segmentarios C5-C6 y su exclusión mediante clipaje.

Conclusiones

La nomenclatura de los segmentos de la carótida interna y de los subtipos de aneurismas paraclinoideos permanece confusa y debería unificarse. Las lesiones deberían identificarse por la localización de su cuello (extradural: segmentos C4 y C5; intradural: segmento C6), la proyección del saco y donde está la cúpula (intradural o extradural). El clipaje de los aneurismas paraclinoideos se beneficia de la clinoidectomía anterior intradural, que es ineludible para tratar los aneurismas trans-segmentarios C5-C6.

Palabras clave:
Apófisis clinoides anterior
Clinoidectomía anterior intradural
Arteria carótida interna
Aneurismas paraclinoideos
Aneurismas trans-segmentarios C5-C6
Summary
Ojective

To present an anatomoclinical study of the intradural anterior clinoidectomy and to evaluate the usefulness of this procedure in the microsurgical management of paraclinoid aneurysms. To describe two cases of a subtype of paraclinoid aneurysms arising from and with their fundus growing both in the clinoidal and subarachnoidal segments of the internal carotid artery (paraclinoid trans-segmentary C5-C6 aneurysms).

Material and methods

The microanatomy of the clinodal region has been studied in dried and fixed specimens. The steps of the intradural anterior clinoidectomy are showed. The imaging and microsurgical findings in two cases of trans-segmentary C5-C6 aneurysms are also described.

Results

The C5 clinoid segment of the internal carotid artery is exposed intradurally after anterior intradural clinoidectomy. The transtion between the C5 clinoid and C6 ophthalmic is also exposed and it is movilized only after the section of the carotid distal ring. These manoeuvres allows the microsurgical management and dipping of the trans-segmentary C5-05 aneurysms.

Conclusions

The nomenclature of the internal carotid artery segments and paraclinoid aneurysms remains confuse. Therefore, each lesion should be idetified by the location of the neck (extradural: C4 and C5 segments; intradural: C6 segment), fundus projection and location (intradural/extradural). The microsurgical clipping of the paraclinoid aneurysms is made easier after intradural anterior clinoidectomy, but this manoeuvre is mandatory for trans-segmentary C5-C6 lesions.

Key words:
Anterior clinoid process
Intradural anterior clinoidectomy
Internal carotid artery
Paraclinoid aneurysms
Trans-segmentary C5-C6 aneurysms

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