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Kenichiro Sugita, Shigeaki Kobayashi, Kazuhiko Kyoshima, and Fukuo Nakagawa

this paper we report the obliteration of unusual aneurysms of the internal carotid artery by means of special clips. Description of Clips Used In the past 3 years we have operated on 450 aneurysms at the Shinshu University Hospital and its five affiliated hospitals. Thirty-six cases (8%) were unusual lesions, having a wide neck, large dome, anomalous shape, or peculiar protrusions. For those cases we used various special kinds of Sugita clip, including L-or J-shaped clips, those with ultralong blades, and fenestrated clips. Fenestrated clips were used in 18

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Koichi Matsuo, Shigeaki Kobayashi, and Kenichiro Sugita

S everal benign processes involving the anterior optic pathways have been reported. 1, 4, 7, 11, 15 Such processes include arteriosclerotic changes of the major intracranial vessels, which may cause compression of the optic nerves or chiasm, producing various visual field defects such as binasal hemianopsia resulting from internal carotid artery (ICA) involvement, or altitudinal hemianopsia by anterior cerebral artery involvement. Bitemporal hemianopsia is extremely rare. We have recently seen a case of bitemporal hemianopsia caused by sclerotic ICA

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Yuichiro Tanaka, Kazuhiro Hongo, Tsuyoshi Tada, Hisashi Nagashima, Tetsuyoshi Horiuchi, Tetsuya Goto, Jun-ichi Koyama, and Shigeaki Kobayashi

clinoid aneurysms, regardless of the relationship between the lesion and the carotid cave. 11 References 1. al-Rodhan NRF , Piepgras DG , Sundt TM Jr : Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33 : 993 – 998 , 1993 al-Rodhan NRF, Piepgras DG, Sundt TM Jr: Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33: 993–998, 1993 2. Batjer HH , Kopitnik TA , Giller CA , et al : Surgery for paraclinoidal carotid artery

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Yuichiro Tanaka, Shigeaki Kobayashi, Kazuhiko Kyoshima, and Kenichiro Sugita

. 6, 26, 27 The purpose of the study was to analyze our surgical experience in the treatment of these aneurysms based on their location and direction, and to analyze the cause of complication in relation to the reconstruction of the parent artery. Clinical Material and Methods Patient Population Sixteen large and nine giant aneurysms of the intradural internal carotid artery (ICA) in 25 patients were surgically treated during the period from 1979 to 1992. The age of the patients ranged from 45 to 77 years, with a mean of 62.6 years. Two patients were men

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Shigeaki Kobayashi, Kazuhiko Kyoshima, Hirohiko Gibo, Sathyaranjandas A. Hegde, Toshiki Takemae, and Kenichiro Sugita

C arotid-ophthalmic artery aneurysms are of considerable surgical interest. 1, 3, 7, 11 With the advent of microsurgical techniques their management has changed from conservative surgery to direct surgical clipping. Fox, 4 Nutik, 9 and Yaşargil, et al. , 11 have classified the aneurysms arising from the inferior wall of the internal carotid artery (ICA) separately and have called them “paraclinoid aneurysms” or “ventral carotid aneurysms.” Some of these were considered unclippable or were associated with disastrous surgical results. 9 There is a small

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Shigeaki Kobayashi, Kenichiro Sugita, and Fukuo Nakagawa

B asilar artery aneurysms are approached via subtemporal, pterional, or transsylvian routes. 1, 7, 8 In the transsylvian route, which is the one most used in our practice, the basilar aneurysm is usually approached lateral to the internal carotid artery (ICA) or the M 1 portion of the middle cerebral artery (MCA). The route between the optic nerve and the ICA is taken in a limited number of cases where a sclerotic carotid artery and its bifurcation are located extremely laterally. In the present case, an approach was made to a basilarsuperior cerebellar

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Kazuhiko Kyoshima, Susumu Oikawa, and Shigeaki Kobayashi

extradurally, because it is difficult to predict the exact point of origin of the OA from the ICA by using any kind of preoperative imaging modality. References 1. Fisher E : Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3 : 300 – 312 , 1938 Fisher E: Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3: 300–312, 1938 2. Gibo H , Lenkey C , Rhoton AL Jr : Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55 : 560 – 574 , 1981 Gibo H, Lenkey

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Fukuo Nakagawa, Shigeaki Kobayashi, Toshiki Takemae, and Kenichiro Sugita

T he vast majority of saccular aneurysms are located at arterial divisions; those arising elsewhere are extremely rare. Ohara, et al. , 8 reported that the pathogenesis of intracranial aneurysms unrelated to arterial junctions was arteriosclerotic; they described a 1% incidence of such aneurysms (11 of 1116 cases) among cerebral aneurysms. During a recent 5-year period, we found eight of these unusual aneurysms protruding from the dorsal wall of the internal carotid artery (ICA) among 460 cases operated on for aneurysm ( Table 1 ). These eight aneurysms

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Neurosurgical Forum: Letters to the Editor To The Editor Stephen Nutik , M.D., Ph.D. The Permanente Medical Group, Inc. Redwood City, California 302 303 I would like to congratulate Kobayashi, et al. , on their article describing carotid cave aneurysms (Kobayashi S, Kobayashi K, Gibo H, et al: Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70: 216–221, February, 1989). Their description of the carotid cave enhances our knowledge of the surgical anatomy of the proximal intracranial

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Toru Koyama, Hiroshi Okudera, and Shigeaki Kobayashi

-old man presented with an unruptured right carotid cave aneurysm of the internal carotid artery (ICA), and clipping was performed using such procedures as resection of the anterior clinoid process and cutting of the distal dural ring ( Fig. 6A ). 13 Postoperatively, we made a computer-generated model of the carotid cave aneurysm by using a previously designed model of the paraclinoid area and the supraclinoid portion of the ICA under full-color shading. 14–16 The source of the input data was a variety of publications that showed the detailed anatomy of the area. 6, 7