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Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping.

Ngando HM, Maslehaty H, Schreiber L, Blaeser K, Scholz M, Petridis AK - Surg Neurol Int (2013)

Bottom Line: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2.Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT

Background: The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.

Methods: Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.

Results: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.

Conclusion: The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

No MeSH data available.


Related in: MedlinePlus

I: Straight and wide or narrow sylvian fissure. II: Wide fissure with herniation of the frontal or temporal lobe. III: Herniation of the frontal or temporal lobe and narrow sylvian fissure. IV: Herniation of the temporal- and frontal-lobe into the fissure
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Figure 2: I: Straight and wide or narrow sylvian fissure. II: Wide fissure with herniation of the frontal or temporal lobe. III: Herniation of the frontal or temporal lobe and narrow sylvian fissure. IV: Herniation of the temporal- and frontal-lobe into the fissure

Mentions: In this study, we retrospectively reviewed the charts of all patients with operatively treated aneurysms at our department from 2003 to 2012 (N = 239) by a classical pterional approach. The preoperative CCTs, digital subtraction angiograms (DSA) and CT angiograms (CTA), were evaluated to specify the anatomy of the SF as characterized by Yasargil. However, we slightly modified the classification to enable categorization on the CCTs (category I-IV)[20] [Figures 1 and 2] and to identify the aneurysms (localization, shape, size).


Anatomical configuration of the Sylvian fissure and its influence on outcome after pterional approach for microsurgical aneurysm clipping.

Ngando HM, Maslehaty H, Schreiber L, Blaeser K, Scholz M, Petridis AK - Surg Neurol Int (2013)

I: Straight and wide or narrow sylvian fissure. II: Wide fissure with herniation of the frontal or temporal lobe. III: Herniation of the frontal or temporal lobe and narrow sylvian fissure. IV: Herniation of the temporal- and frontal-lobe into the fissure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814910&req=5

Figure 2: I: Straight and wide or narrow sylvian fissure. II: Wide fissure with herniation of the frontal or temporal lobe. III: Herniation of the frontal or temporal lobe and narrow sylvian fissure. IV: Herniation of the temporal- and frontal-lobe into the fissure
Mentions: In this study, we retrospectively reviewed the charts of all patients with operatively treated aneurysms at our department from 2003 to 2012 (N = 239) by a classical pterional approach. The preoperative CCTs, digital subtraction angiograms (DSA) and CT angiograms (CTA), were evaluated to specify the anatomy of the SF as characterized by Yasargil. However, we slightly modified the classification to enable categorization on the CCTs (category I-IV)[20] [Figures 1 and 2] and to identify the aneurysms (localization, shape, size).

Bottom Line: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2.Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Klinikum Duisburg, Academic Teaching Hospital of University Essen-Duisburg, Germany.

ABSTRACT

Background: The sylvian fissure (SF) is the anatomical pathway used in a pterional approach, which leads to most aneurysms. There are four different anatomical variants of the SF described. In the present retrospective study the four different categories of the SF were studied in order to evaluate any correlation of these variants to surgical outcome.

Methods: Patients treated for intracranial aneurysms by a pterional transsylvian approach during 2003-2012 (N = 237) were included in the study. The SF category was determined by analysis of preoperative computed tomography (CT) scanning. Patients were grouped into unruptured intracranial aneurysms (UIA) and ruptured intracranial aneurysms with subarachnoid hemorrhage (SAH) according to the Hunt and Hess grades. Brain edema, vasospasms, ischemic lesion rate, and outcome were evaluated for possible correlation with SF anatomical variants.

Results: Postsurgically brain edema formation correlated significantly with more complex anatomical variants of the SF in patients with UIAs and in patients with Hunt and Hess 1 and 2. Ischemia rate, vasospasms, or clinical outcome was not negatively affected though.

Conclusion: The classification of the SF as proposed by Yasargil is more than a pure anatomical observation. In this retrospective study, we show that the anatomical variants of the SF can be associated to postoperative complications like formation of brain edema or ischemic lesions Preoperative knowledge of the SF anatomy and possibly consecutive adapted extend of the surgical approach can decrease procedure-related morbidity.

No MeSH data available.


Related in: MedlinePlus