Bone anatomic variations of the parasellar region and its technical implications in para clinoid and posterior communicating segment aneurysms microsurgical clipping - Technical note.

Background: Microsurgical treatment of paraclinoid aneurysms is a complex task that generally requires anterior clinoid process (ACP) removal to obtain adequate surgical exposure. This procedure poses a considerable technical difficulty due to the association of the ACP to critical neurovascular structures. Furthermore, anatomical variations in the parasellar region, such as the caroticoclinoid foramen (CCF) or an interclinoid bridge (ICB), may impose additional challenges and increase surgical complications. The present study aims to briefly review some anatomic variations in the parasellar region and describe a step-by-step surgical technique for a hybrid anterior clinoidectomy based on the senior author's experience. Methods: We present two cases with bone variations on the parasellar region in patients with a paraclinoid aneurysm and another with a posterior communicating segment aneurysm treated by microsurgical clipping at our hospital. Results: We focused on safely dealing with these variations during surgery, without further complications, and with good postoperative results. Patients were discharged with no significant deficit. Postoperative control, computed tomography angiography showed complete exclusion of aneurysms. Conclusion: Although anatomical variations in the parasellar region can complicate surgical clipping of these aneurysms, it is essential to ensure the best possible surgical outcome to conduct thorough preoperative and radiological evaluations.

Paraclinoid aneurysms clipping through an extradural sphenoid ridge keyhole approach.

BACKGROUND: Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical complexity of this region. Then, innovative techniques such as the extradural sphenoid ridge approach are suitable for a safe microsurgical clipping. METHOD: A description of the surgical technique was made by the senior author, a vascular neurosurgeon experienced with the use of this approach in the management of paraclinoid aneurysms exemplified through a clinical case. CONCLUSION: Microsurgical clipping through an extradural sphenoid ridge keyhole approach for small and midsize paraclinoid aneurysms is an excellent treatment modality with good clinical and surgical results.

Collet-Sicard syndrome: a scoping review.

Collet-Sicard syndrome (CSS) is the unilateral palsy of the cranial nerves (CN) IX, X, XI, and XII. To our knowledge, no review describes the characteristics of patients diagnosed with CSS. Therefore, this review aims to collect and describe all cases in the literature labeled as CSS. We performed a scoping review of the literature and conducted a database search in Embase and PubMed. We included articles and abstracts with case reports or case series of patients with CSS diagnosis. We classified the cases into two groups: "CSS", referring to patients presenting exclusively with IX-XII nerve involvement, and "CSS-plus", which corresponds to cases with CSS and other neurological impairments. We included 135 patients from 126 articles, of which 84 (67.7%) were male. The most common clinical manifestations reported were dysphagia and dysphonia. The most common etiology was tumoral in 53 cases (39.6%) and vascular in 37 cases (27.6%). The majority of patients showed partial or total improvement, with just over half receiving conservative treatment. The most frequent anatomic space was the jugular foramen (44.4%) and the parapharyngeal retrostyloid space (28.9%). Approximately 21% of the patients had other CN impairments, with the seventh and eighth CN most frequently compromised. We conclude that although there is a need for greater rigor in CSS reporting, the syndrome has a clear utility in identifying the localization of jugular foramen and parapharyngeal retrostyloid space pathology.