Importance of the exploration of the lateral recess of the interpeduncular cistern in aneurysms of the communicating segment of the internal carotid and posterior communicating artery: preservation of the thalamic perforating arteries.

Importancia de la exploración del receso lateral de la cisterna interpeduncular en aneurismas del segmento comunicante de la carótida interna y arteria comunicante posterior: preservación de las arterias tálamoperforantes.

Abstract

Abstract
Objective: To describe the usefulness of clinoidectomy in this type of aneurysm.
Description: We performed a conventional pterional approach, with extradural clinoidectomy and carotid, chiasmatic and lamina terminalis cisternal dissection, with access to the interoptic, optic chiasm, optic-carotid Dissection from proximal to distal, starting from the supraclinoid carotid until identifying the segment and the posterior communicating artery, followed by dissection of the aneurysm and clipping, corroborating the patency of the Pcoma as well as its branches (tuberoinfundibular, premamilar and thalamoperforating arteries) with the use of fluorescein.
Conclusion: Anterior clinoidectomy should be included in the clipping of all aneurysms originating from both ACI-PCom and Pcoma, which would reduce the risk of morbidity associated with premamilar artery injury.