Abstract
Because of the recent development of high-performance 3-dimensional computed tomography (3D-CTA), magnetic resonance angiography (MRA) and the consideration of the risk of digital subtraction angiography (DSA), DSA is not always necessary in performing surgery for cerebral aneurysms. However, DSA was necessary in patients in whom the ophthalmic artery from the internal carotid artery (IC) was not visualized on 3D-CTA or MRA, in order to predict the risk of blindness after front-temporal craniotomy.
In this study, we investigated the preoperative evaluation and the surgical procedure for 330 cases of front-temporal craniotomy for surgery of aneurysm over the past 4.5 years. There were 5 cases without ophthalmic artery from IC in DSA or 3D-CTA, 4 cases with an anomalous ophthalmic artery arising from the middle meningeal artery and 1 case with an anomalous ophthalmic artery arising from unknown origin. Microsurgical procedure is needed to preserve the middle meningeal artery in front-temporal craniotomy in these cases with an anomalous ophthalmic artery arising from the middle meningeal artery, because this anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed in front-temporal craniotomy.
Front-temporal craniotomy is difficult in cases with an anomalous ophthalmic artery arising from an unknown origin.
