Ventral Wall Research Articles

Effects of an Acute Pain Service on Planned Ventral Wall Hernia Repair in a Matched Retrospective Cohort

Background: An Acute Pain Service (APS) has been shown to improve patient outcomes and decrease complications by achieving adequate pain control and decreasing opioid use. However, it is less obvious if having a dedicated APS postoperatively directly translates to patient-centered or hospital cost benefits. This study aimed to determine if there was a cost benefit between a matched cohort of patients with and without a dedicated APS after a planned ventral wall hernia repair. Methods: A historical cohort study was conducted. After 1:1 matching, 40 patients were included for analysis. The non-APS group received a thoracic epidural postoperatively managed by the anesthesiology department. The APS group received various continuous peripheral nerve blocks and analgesia exclusively managed by a dedicated APS. Data was recorded for each group regarding surgical techniques, postoperative complications, opioid use and induced side effects, hospital length of stay, and resource utilization for both groups. Results: Compared to the non-APS group, adjusted opioid consumption per day was almost half in the APS group (P= 0.0067). The average hospital length of stay was 3.4 days less (P= 0.0401) , and there was a statistically significant reduction in several recovery milestones that likely contributed to a timely discharge in the APS group. After factoring costs of APS utilization, the APS was shown to save an average of $5,440.59 of total cost per patient. Discussion: The addition of a dedicated postoperative APS significantly reduced opioid consumption and improved outcomes of patients and resulted in reduced healthcare costs.

Double-layered two-directional somatopleural cell migration during chicken body wall development revealed with local fluorescent tissue labeling.

The thoracic ventral body wall consists of the rib, the sternum, the intercostal muscles, and the connective tissues surrounding them. The ribs and the intercostal muscles are derived from the somite. The connective tissues are derived from the somatic layer of the lateral plate mesoderm, somatopleure. The lateral growth of the somatopleure forms the primary ventral body wall. The migration of somitic cells into the somatopleure generates the secondary body wall. As the migrating behavior of the somatopleural cells during secondary body wall formation is still unclear, we investigate here the migratory behavior of the somatopleural cells in the thorax during chicken ventral body wall development by labeling the thoracic somatopleural cells one-somite-wide by DiI labeling or gene transfection of the enhanced green fluorescent protein and observe their distribution assisted by the tissue-clearing technique FRUIT. Our labeling experiments revealed the rostral migration of the somatopleural cells into a deep part of the thoracic body wall in embryonic day 6.5 chickens. For embryonic day 8.5 chickens, these deep-migrating somatopleural cells were found around the sternal ribs. Thus, we identified the double-layered two-directional migrating pathways of the somatopleural cells: the rostral migration of the deep somatopleural cells and the lateral migration of the superficial somatopleural cells. Our findings imply that the rostral migration of deep somatopleural cells and the lateral migration of superficial ones might be associated with the developing sternal ribs and the innervation of the thoracic cutaneous nerves, respectively.

Favorable Outcomes After Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Noncomplex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-analysis.

To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For noncomplex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. Ninety-three studies representing 12,440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% [95% confidence interval (CI): 2.2%-4.2%, n = 11,049] after minimally 12months and 4.1%, (95%CI: 2.9%-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2%-6.4%, n = 4891) and 5.5% (95%CI: 4.4%-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair [odds ratios (OR): 0.27, 95%CI: 0.15-0.51, P < 0.001] and equal recurrence rates compared to intraperitoneal onlay mesh (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, P = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03 -3.14, P = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7%-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8%-2.8%, n = 982), albeit based on non-randomized studies. Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except SSI. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.

Elective incisional hernia repair: lower risk of postoperative wound infection with laparoscopic versus open repair.

The superiority of laparoscopic repair over open repair of incisional hernias (IHs) in the elective setting is still controversial. Our study aimed to compare the postoperative outcomes of laparoscopic and open elective IH repair in an Asian population. This retrospective study was conducted in an acute general hospital in Singapore between 2010 and 2015. Inclusion criteria were IH repair in an elective setting, IHs with diameter of 3-15 cm, and location at the ventral abdominal wall. We excluded patients who underwent emergency repair, had recurrent hernias or had loss of abdominal wall domain (i.e. hernia sac containing more than 30% of abdominal contents or any solid organs). Postoperative outcomes within a year such as recurrence, pain, infection, haematoma and seroma formation were compared between the two groups. There were 174 eligible patients. The majority were elderly Chinese women who were overweight. Open repair was performed in 49.4% of patients, while 50.6% underwent laparoscopic repair. The mean operation time for open repair was 116 minutes (116 ± 60.6 minutes) and 139 minutes (136 ± 64.1 minutes) for laparoscopic repair (P = 0.079). Within a year after open repair, postoperative wound infection occurred in 15.1% of the patients in the open repair group compared to 1.1% in the laparoscopic group (P = 0.0007). Postoperative pain, recurrence and haematoma/seroma formation were comparable. Elective laparoscopic IH repair has comparable outcomes with open repair and may offer the advantage of reduced postoperative wound infection rates.

Organization of dermal glands and characteristic of secretion in the freshwater mite, Limnesia maculata (O. F. Müller, 1776) (Acariformes, Limnesiidae).

The presence of dermal glands is a synapomorphy in the freshwater mites-the large branch of the hyporder Parasitengonina. Dermal glands of the mite Limnesia maculata (O. F. Müller, 1776) (Acariformes, Limnesiidae) were studied using light and electron microscopy (TEM and SEM) for the first time. Two types of dermal glands were recognized in adult mites-14 pairs of the uniformly organized common dermal glands scattered throughout the entire body volume, and one pair of the characteristic so-called idiosomal dermal glands centrally located and stretched along the ventral body wall, supposedly corresponding to the epimeroglandularia 4. The common dermal glands are composed of a single large alveolus with the basally located columnar epithelium. An intra-alveolar lumen is positioned above the epithelium and packed with a secretion in the form of long curved electron-dense bands. These bands are directed to the excretory opening and released to the outside in the form of strongly coiled bands. The cytoplasm of the common dermal glands is filled with short RER cisterns and shows few characteristic Golgi bodies with round dense secretory granules at the distal pole. In contrast, a large elongated sac represents the idiosomal dermal glands having a relatively thin secretory epithelium on the periphery. The cuboidal epithelial cells contain areas with tightly packed RER cisterns and weakly recognized Golgi bodies. The apical cell surface bears irregular short microvilli. The large intra-alveolar lumen always contains an electron-dense secretion with myriads of small lighter particles. This kind of secretion was never seen released through the opening. The excretory opening of the common and the idiosomal dermal glands shows differences in its organization but basically is represented by a cuticular "bell" narrowing to the opening and showing a particular kind of valves at the inner side of the flaps of the orifice.

Vascular endothelial growth factor c regulates hematopoietic stem cell fate in the dorsal aorta.

Hematopoietic stem and progenitor cells (HSPCs) are multipotent cells that self-renew or differentiate to establish the entire blood hierarchy. HSPCs arise from the hemogenic endothelium of the dorsal aorta (DA) during development in a process called endothelial-to-hematopoietic transition. The factors and signals that control HSPC fate decisions from the hemogenic endothelium are not fully understood. We found that Vegfc has a role in HSPC emergence from the zebrafish DA. Using time-lapse live imaging, we show that some HSPCs in the DA of vegfc loss-of-function embryos display altered cellular behavior. Instead of typical budding from the DA, emergent HSPCs exhibit crawling behavior similar to myeloid cells. This was confirmed by increased myeloid cell marker expression in the ventral wall of the DA and the caudal hematopoietic tissue. This increase in myeloid cells corresponded with a decrease in HSPCs that persisted into larval stages. Together, our data suggest that Vegfc regulates HSPC emergence in the hemogenic endothelium, in part by suppressing a myeloid cell fate. Our study provides a potential signal for modulation of HSPC fate in stem cell differentiation protocols.

Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence.

There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template. The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported. The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.

The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction

The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction

The lumbar hernia

Lumbar hernias are rarely encountered as compared to other ventral abdominal wall hernias and are often misdiagnosed and overlooked. They account for less than 1.5% of all abdominal hernias. Fewer than 300 cases have been reported over the past 300 years. A lumbar hernia is defined as a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. It must be distinguished from a lipoma, cold (tuberculous) abscess or a pseudo-hernia due to local muscular paralysis. Presenting a case of 65-year-old female who came to surgery OPD with complaint of a swelling in the right lumbar area since 5 years. On examination, a smooth and non-tender swelling measuring approximately 4 x 3 cm was evident in right lumbar region. We proceeded with a lumbar ultrasound which confirmed the presence of the hernia in posterior abdominal wall. Later, the patient was admitted for surgery under spinal anaesthesia. An open approach was performed and intraoperative findings revealed retroperitoneal fat, intermuscular lipoma and a small hernia sac as contents of swelling. It is very unusual to find lumbar hernias presenting with a lipoma, as in our case, the clinical findings alone can be very confusing and increase the chances of incorrect diagnosis and subsequent treatment. Inability of clinical examination and ultrasonography alone in making an adequate diagnosis of lumbar hernia in preoperative setting mandates a routine CT/MRI for all such patients, to ensure surgeons have a correct diagnosis before proceeding for surgery. Ideal management is just like other hernias, i.e., with mesh hernioplasty either laparoscopically or through an open approach.

Fluoroscopic Detection of Ventral Wall Violation during C2 Intralaminar Screw Insertion: A Descriptive Study

Introduction: The C2 (second cervical) laminar screws were considered for rigid fixation of the axis because the use of pars or pedicle screws posed a risk to the vertebral artery with C2. Though considered to be a relatively safe method, ventral spinal canal violations have been reported in laminar screws fixations. Fluoroscopy-based image guidance may increase the accuracy and safety of the technique. Aim: To report the use of fluoroscopy technique in the detection of ventral wall violation during C2 intralaminar screw insertion. Materials and Methods: This descriptive study reports seven dry axis vertebrae from the adult south Indian population for which fluoroscopic analysis was done from January 2013 to December 2013. True lateral views were taken before and after applying a vertical line of barium paint on the ventral surface of the lamina at two points: at the centre of the lamina and close to the facet joints at the face to-laminar junction. Results: In the total seven dry axis vertebrae analysed, the mean ratio of the distance from the spinolaminar junction to the barium line (drawn on the ventral surface of the lamina just next to face to laminar junction) to the distance between the spinolaminar junction and uppermost part of inferior articular facet of C2 vertebrae was 0.465±0.0389 mm. Conclusion: Even though considered a relatively safer technique, laminar cortical violations have been reported in C2 translaminar screw fixations. Fluoroscopy-based imaging guidance can improve the accuracy of C2 translaminar screw insertion, as this technology provides real-time imaging during the process of screw insertion and helps in accurate screw sizing.

3224 – NFAT TRANSCRIPTION FACTORS ARE REQUIRED FOR DEFINITIVE HEMATOPOIESIS

Hematopoietic stem cells (HSCs) are a population of tissue-specific stem cells that give rise to all mature blood lineages throughout adult life. During embryonic development, HSCs arise from specialized endothelium in the ventral wall of the dorsal aorta (DA), known as the hemogenic endothelium (HE). Key transcription factors encoded by gata2b, runx1, and cmyb mark HSCs during their earliest specification and emergence from the HE and are functionally required across vertebrate phyla. Here we show that members of the nuclear factor of activated T-cells (Nfat) family of transcription factors are also required for proper HSC specification. Pharmacological inhibition of upstream activators of Nfat—calmodulin and calcineurin—reduces the number of HSC precursors in the developing zebrafish embryo. Although five nfat family members are expressed in the DA at 24 hours post fertilization (hpf), knockdown of only two—nfatc1 and nfatc3b—is sufficient to diminish HSC specification as indicated by reduction of precursors expressing runx1 and cmyb, as well as a loss of early definitive T lymphocytes expressing rag1. We show that despite definitive hematopoietic defects in Nfatc1/c3b morphants, earlier vascular patterning (cdh5) and arterial identity (notch1b and efnb2a) are intact, and that competent hemogenic endothelium (gata2b) is available. We are currently genetically verifying findings by generating nfatc1 and nfatc3b knockout zebrafish lines. We are also testing if endothelial-specific expression of nfatc1 and nfatc3b is sufficient to drive HSC generation. These results uncover a previously unknown role of two Nfat family transcription factors in combinatorially regulating specification of HSCs in the developing embryo. Hematopoietic stem cells (HSCs) are a population of tissue-specific stem cells that give rise to all mature blood lineages throughout adult life. During embryonic development, HSCs arise from specialized endothelium in the ventral wall of the dorsal aorta (DA), known as the hemogenic endothelium (HE). Key transcription factors encoded by gata2b, runx1, and cmyb mark HSCs during their earliest specification and emergence from the HE and are functionally required across vertebrate phyla. Here we show that members of the nuclear factor of activated T-cells (Nfat) family of transcription factors are also required for proper HSC specification. Pharmacological inhibition of upstream activators of Nfat—calmodulin and calcineurin—reduces the number of HSC precursors in the developing zebrafish embryo. Although five nfat family members are expressed in the DA at 24 hours post fertilization (hpf), knockdown of only two—nfatc1 and nfatc3b—is sufficient to diminish HSC specification as indicated by reduction of precursors expressing runx1 and cmyb, as well as a loss of early definitive T lymphocytes expressing rag1. We show that despite definitive hematopoietic defects in Nfatc1/c3b morphants, earlier vascular patterning (cdh5) and arterial identity (notch1b and efnb2a) are intact, and that competent hemogenic endothelium (gata2b) is available. We are currently genetically verifying findings by generating nfatc1 and nfatc3b knockout zebrafish lines. We are also testing if endothelial-specific expression of nfatc1 and nfatc3b is sufficient to drive HSC generation. These results uncover a previously unknown role of two Nfat family transcription factors in combinatorially regulating specification of HSCs in the developing embryo.

The cell type-specific ER membrane protein UGS148 is not essential in mice.

Genomes of higher eukaryotes encode many uncharacterized proteins, and the functions of these proteins cannot be predicted from the primary sequences due to a lack of conserved functional domains. In this study, we focused on a poorly characterized protein UGS148 that is highly expressed in a specialized cell type called tanycytes that line the ventral wall of the third ventricle in the hypothalamus. Immunostaining of UGS148 revealed the fine morphology of tanycytes with highly branched apical ER membranes. Immunoprecipitation revealed that UGS148 associated with mitochondrial ATPase at least in vitro, and ER and mitochondrial signals occasionally overlapped in tanycytes. Mutant mice lacking UGS148 did not exhibit overt phenotypes, suggesting that UGS148 was not essential in mice reared under normal laboratory conditions. We also found that RNA probes that were predicted to uniquely detect UGS148mRNA cross-reacted with uncharacterized RNAs, highlighting the importance of experimental validation of the specificity of probes during the hybridization-based study of RNA localization.

The OEIS complex – clinical &amp; radiological evaluation

The OEIS complex comprises a constellation of complex and severe malformations of the abdominal wall, gastrointestinal and genitourinary tracts, and spinal cord. The malformation results from improper closure of the ventral abdominal wall due to failure of convergence of cephalo-caudal and lateral folding of the embryo during early gestation. The rarity of the condition suggests etiologic heterogeneity and the possible role of environmental and genetic factors. We present clinical and imaging findings of the OEIS complex in a neonate.

Comparative Study between Intraperitoneal Onlay Mesh Repair (IPOM) vs Intraperitoneal Onlay Mesh Repair with Closure of Fascial Defect (IPOM PLUS) for Ventral Hernias

Introduction: In the recent times, minimal access surgery for ventral hernias is becoming popular. However several issues like postoperative pain, recurrence, seroma formation arising due to the procedure are yet to be resolved. To find a solution to the above mentioned issues, closing the defect in the fascia laparoscopically along with reinforcement by mesh has been tried. About The Study: It was a prospective randomized study done at KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES BENGALURU from October 2018 to March 2020. Aims and Objectives: To compare between intra peritoneal onlay mesh repair (IPOM) V/S intra peritoneal onlay mesh repair with closure of fascial defect (IPOM PLUS) for ventral abdominal wall hernias. To study: 1) Postoperative bulge (pseudo hernia). 2) Seroma formation. 3) Pain in the postoperative period. 4) Recurrence. 5) Early return to normal activity especially forward bending. Materials and Methods: The study was conducted on 40 patients. All of them underwent surgery on an elective basis...A pneumoperitoneum of 12-15mmhg was built up by inflating through veress needle at the palmer’s point. A camera port and two working ports were inserted .The sac of the hernia was excised after cutting the adhesions. The defect was closed from within with self sustaining continuous /interrupted non absorbable sutures. A composite mesh was oriented with transfascial sutures. Additional tackers applied if required. Patients are divided into two groups of 20 each namely the closure and the non closure groups respectively. Each patient was assessed for pain, seroma, forward bending and pseudo bulge on postop day 1,3 and day of discharge. Patient is called for follow up after, 1 month and 6 months. Conclusion: Patients who underwent IPOM PLUS had a decreased incidence of seroma formation, recurrence, postoperative bulge and a early return to normal activity when compared to those who underwent IPOM.

P138 PREPERITONEAL ENDOSCOPIC GROIN HERNIA SURGERY - REASSESSMENT OF TOPOGRAPHIC ANATOMY AS A BASIS FOR STANDARDIZED DESCRIPTION OF SURGICAL STEPS

Abstract Aim Fascial groin anatomy remains a conundrum. In particular, a clear anatomical allocation of the correct extraperitoneal dissection planes and spaces in total extraperitoneal endoscopic hernia surgery (TEP) has not yet agreed upon. The differing anatomical concepts are reflected by the variability of surgical approaches, the considerably long learning curves and subsequent complications. Thus, the aim of this study was to reassess the topographic anatomy of the groin region providing a basis to standardize the surgical steps of TEP according to clearly defined anatomical landmarks. Material and Methods Video analysis of intraoperative surgical anatomy of groin hernia patients was correlated with the findings retrieved by macroscopic anatomical studies. The groin region of formalin fixed body donors was subjected to a stepwise dissection exposing the fascial system of the abdominal wall layer-by-layer and via different angles. Selected areas of interest were processed for histological study. Surgically relevant anatomical landmarks were defined and termed according to the most appropriate anatomical nomenclature. Results The essential surgical dissection steps during TEP could be related to specific anatomical landmarks extending within the extraperitoneal space of the ventral and dorsolateral abdominal wall. The definition of fascial structures and interfaces and the identification of structures at risk allowed the identification of correct dissection planes for mesh placement. Conclusions Our study helps to clarify the definition and nomenclature of anatomical key structures required for a standardized description of TEP in a simplified model. The data may contribute to reduce complications and improve surgical teaching and training.

Urinary bladder duplication in coronal plane in a dog

AbstractAn 8‐year‐old female intact Yorkshire terrier was presented with a 1‐year recurrent urinary tract infection. Abdominal ultrasound, computed tomography, positive contrast retrograde urethrography and cystoscopy were performed, revealing a tubular structure continuous with the ventral wall of the bladder connected with the urethra by an ostium ventral to the internal urethral orifice. Excision of the tubular structure was performed. Histopathological results were consistent with urinary bladder tissue. One year after surgery no clinical signs were reported. To the authors’ knowledge, this is the first report of urinary bladder duplication in the coronal plane with a single urethra in a dog.

Waist Circumference is not Superior to Body Mass Index in Predicting Groin Hernia Repair in Either Men or Women

Background and aimsA high body mass index (BMI) is considered a risk factor for ventral abdominal wall hernias but protective for the development of groin hernias. The reason for this is unclear. The surrounding abdominal fat in obesity might “protect” and limit the passage through the inguinal canal. The aim was to compare two different methods used for obesity registration in groin hernia patients and to investigate the hypothesis of high BMI/low groin hernia risk phenomenon.MethodsThis was a population-based observational study comparing BMI to waist circumference (WC) as well as their correlations to the quantity of groin hernia repair performed in either sex. Two national registers were crosslinked to a large regional register including information on WC.ResultsA larger WC and a higher BMI were associated with a lower risk of having groin hernia repair in both sexes. There was no difference using either WC or BMI as a risk factor for groin hernia repair in either sex. There was no advantage to using body composition based on WC rather than BMI for surgery indication.ConclusionsOverweight patients, both men and women, have a lower risk of undergoing groin hernia repair regardless of fat distribution. BMI is a well-established method for obesity registration and is recommended in the evaluation of hernia patients.

Interclavicularis anticus digastricus muscle in a female body donor: a case report

Background and objectivesMuscular variations of the ventral thoracic wall are generally common and of great clinical interest.Materials and methodsAn unusual muscular variation of the ventral thoracic wall was observed and dissected in a West-European female body donor.ResultsAn interclavicularis anticus digastricus muscle was observed and studied. It originated from the manubrium sterni and inserted bilaterally to the clavicles. Both muscle bellies were interconnected by a tendon on the ventral surface of the manubrium sterni. The muscle was innervated by branches of the lateral pectoral nerve.ConclusionsThe interclavicularis anticus digastricus muscle is a muscular variation of the ventral thoracic wall of unknown prevalence. This variation might be of clinical interest in orthopaedics and thoracic surgery. It is also a vulnerable structure during infraclavicular insertion of a subclavian vein catheter or fractures of the clavicle.

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

OEIS Syndrome: Omphalocele, Exstrophy of the Cloaca, Imperforate Anus, and Spinal Defects

Ophthalmic Segment Aneurysms: Surgical Treatment and Outcomes.

Background Surgical treatment of ophthalmic segment aneurysms (OSAs) remain challenging because of complex anatomy surrounding the aneurysm and entails extensive drilling of anterior clinoid process to define proximal neck of the aneurysm and carotid exposure in the neck for proximal control. Materials and Methods Authors present a retrospective analysis of 36 aneurysms in 35 patients with OSAs operated surgically by first author. Surgical clipping was done for the aneurysms as primary modality of treatment along with wrapping and trapping as required. Results Commonest age group was 40 to 60 years with female preponderance of 3:1. Maximum (23) patients presented with subarachnoid hemorrhage (WFNS Gr 1), followed by asymptomatic patients (six). There were 18 small, 14 large, and four giant aneurysms, 15 dorsal wall, 17 ventral wall, three proximal posterior wall, and one blister aneurysm. Good outcome, as measured by Glasgow Outcome Score (GOS) was achieved in 29 patients. Conclusion OSAs are technically demanding aneurysms, but with due diligence to surgical principles, good outcomes may be obtained.