How I do it: proximal control in parkinson\u2019s triangle for a very large paraclinoid aneurysm

Victor Volovici,Ruben Dammers

doi:10.1007/s00701-021-04961-6

Abstract

BackgroundParaclinoid aneurysms, especially when they are large, can be quite difficult to treat, both endovascularly and through microsurgical clip reconstruction. There are many possibilities to approach this region surgically, and most hinge on total or partial removal of the anterior clinoid process. Gaining proximal control may be a challenge when space is limited, which is why Parkinson’s triangle may be a viable alternative in some cases.MethodsWe describe in a stepwise fashion the steps used to reconstruct a very large paraclinoid aneurysm. We first attempted to gain proximal control in the carotid cave and later in Parkinson’s triangle because of limited manoeuvrability.ConclusionProximal control in Parkinson’s triangle can be a safe alternative when the post-clinoidal segment of the internal carotid artery (ICA) is short and working space is limited in paraclinoid aneurysm microsurgical clip reconstruction.

Highlights

Paraclinoid aneurysms are difficult lesions to treat, both microsurgically and endovascularly [6, 9]
The triangle was described in a case report published in 1965 by Dwight Parkinson [10]
Despite the fact that indications for these lesions are declining, these pioneers paved the way for current neurosurgeons to tackle challenging aneurysms with a varied armamentarium

Summary

Introduction

Paraclinoid aneurysms are difficult lesions to treat, both microsurgically and endovascularly [6, 9]. The presence of the anterior clinoid and of the distal dural ring of the clinoidal carotid artery limits options for adequate proximal control. One pre-requisite for safe dissection and microsurgical clip reconstruction of these lesions is the anterior clinoidectomy, performed in either an extradural [8] or intradural [2] fashion.

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