BACKGROUND: Clipping of ophthalmic artery (OA) aneurysms present one of the treatment strategies for long-term disease management. Existing surgical techniques primarily require extra/intradural removal of the anterior clinoid process, carrying a higher risk of infection, damage to surrounding structures or technical complications. METHODS: We present the technique of minimally invasive partial medial clinoidectomy with the unroofing of the optic canal for surgical clipping of OA aneurysms, and besides its pros and cons, we also discuss proper technical indications. CONCLUSION: The partial medial clinoidectomy improves manoeuvrability around the paraclinoid region, provides better protection for adjacent structures and renders excellent treatment outcome.

• MeSH
• arteria carotis interna chirurgie   MeSH
• arteria ophthalmica * diagnostické zobrazování   chirurgie   MeSH
• intrakraniální aneurysma * diagnostické zobrazování   chirurgie   MeSH
• klínová kost chirurgie   MeSH
• lidé MeSH
• neurochirurgické výkony metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

We investigated the usefulness of cerebrovascular reserve (CVR) testing to predict severe hemodynamic changes during proximally protected carotid artery stenting. Of 90 patients referred, 63 eligible underwent complete evaluation of the extent of carotid artery disease and transcranial Doppler ultrasound (TCD) assessment of CVR by means of a breath-holding test and ophthalmic artery flow pattern evaluation. Periprocedural TCD monitoring of the ipsilateral middle cerebral artery flow was performed in 24 patients undergoing proximally protected procedure (requiring induction of flow arrest within internal carotid artery). Abnormal CVR was significantly less common in patients with unilateral compared to bilateral carotid artery disease (26.3 % vs. 76.9 %, p=0.02), while ophthalmic artery flow reversal was rare in patients with unilateral carotid artery disease (2.5 % vs. 42.9 %, p<0.01). During the induction of carotid flow arrest, the average mean flow velocity drop following external carotid artery occlusion was low (3.5 %, p=0.67) compared to the induction of complete flow arrest (32.8 %, p<0.01). Six patients had a total mean flow velocity drop >50 %, including 2 patients with normal pre-procedural CVR. Our results suggest that TCD evaluation of CVR is not a reliable predictor of hemodynamic changes induced during proximally protected carotid artery stenting in patients with unilateral carotid artery disease.

• MeSH
• arteria carotis interna diagnostické zobrazování   fyziologie   MeSH
• arteria ophthalmica diagnostické zobrazování   fyziologie   MeSH
• hemodynamika fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mozkový krevní oběh fyziologie   MeSH
• prediktivní hodnota testů MeSH
• rychlost toku krve fyziologie   MeSH
• senioři MeSH
• stenóza arteria carotis diagnostické zobrazování   patofyziologie   MeSH
• stenty * MeSH
• ultrasonografie dopplerovská transkraniální metody   normy   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH