Impact of Anterior Clinoidectomy on Visual Function After Paraclinoid Carotid Artery Aneurysm Surgery: Power-Drill Versus No-Drill Technique. Issue 2 (6th May 2021)

• Record Type: Journal Article
• Authors: Niibo, Takeya; Takizawa, Katsumi; Sakurai, Jurou; Takebayashi, Seizi; Koizumi, Hiroyasu; Kobayashi, Toru; Kobayashi, Rina; Kuris, Kouta; Gotou, Syusuke; Tsuchiya, Ryousuke; Kamiyama, Hiroyasu
• Is Part Of: Neurosurgery open. Volume 2:Issue 2(2021)
• Publication Date: 2021-05-06
• Subjects: Aneurysm -- Anterior clinoidectomy -- Paraclinoid aneurysm -- Visual function; Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.1093/neuopn/okab016
• Languages: English
• ISSNs: 2633-0873

Abstract

ABSTRACT: BACKGROUND: Few studies have attempted to make a direct comparison of the risk of visual impairment following extradural anterior clinoidectomy (EAC) with and without the use of a power drill. OBJECTIVE: To evaluate postoperative visual outcomes between groups of patients with paraclinoid carotid artery aneurysms (PCAAs) who underwent surgical clipping with and without the use of a power drill during EAC. METHODS: Between January 2010 and November 2019, 90 patients, 7 with ruptured and 83 with unruptured PCAAs, underwent clipping surgery at our hospital. The authors retrospectively analyzed postoperative visual complications from the medical records of these patients. RESULTS: Among the 85 patients (excluding 3 patients with disturbance of consciousness caused by subarachnoid hemorrhage and 2 patients with preoperative visual disturbance) evaluated, EAC was conducted using a power drill in 64 patients and using a microrongeur in 21 patients. Permanent postoperative visual impairment developed in 14 (21.9%) patients in the drill group: 9 patients had ipsilateral lower nasal quadrant hemianopsia (ILNQH) and 5 patients had ipsilateral visual acuity reduction. Transient ILNQH developed in only 1 patient in the no-drill group. The incidence of permanent postoperative visual impairments was significantly lower in the no-drill group than in the drill group ( P = .020). Seventeen (26.6%) patients developed transient oculomotor nerve palsy in the drill group, while no patients developed oculomotor nerve palsy in the no-drill group. CONCLUSION: EAC using a microrongeur versus a power drill significantly improved visual outcomes after clipping surgery for PCAAs.