Introduction: Ophthalmic region aneurysms present unique surgical challenges given their proximity to the skullbase, optic canal and anterior clinoid process. Adequate exposure of the aneurysm neck for microsurgical clipping may require anterior clinoidectomy. The visual outcomes following this maneuver using the SONOPET® Ultrasonic Aspirator (Stryker, Kalamazoo, MI) compared to standard use of a high-speed drill is not well known.
Methods: We retrospectively reviewed an IRB approved, prospectively maintained institutional aneurysm database to identify all patients with ophthalmic region aneurysms in whom an anterior clinoidectomy was performed from January 2010 to January 2014. Medical records were reviewed for age, sex, race, aneurysm location, aneurysm size, the use of temporary clipping, rupture status, length of hospital stay and early visual outcomes. Early visual outcomes were defined by those which occurred before hospital discharge. Visual function was rated as either 1)no new visual deficits or 2)any new visual deficits.
Results: Thirty-three patients underwent 33 craniotomies for the treatment of 42 aneurysms. An anterior clinoidectomy was performed in all patients using either the SONOPET Ultrasonic Aspirator or a high-speed drill. There was no difference between these two groups for median age(p=0.52), sex(p=0.53), race(p=0.65), the use of temporary clipping(p=0.83), ruptured status(p>0.99) or length of hospital stay(p=0.10). There was a small but statistically significant difference in median aneurysm size between the SONOPET group (3.25mm, range:0.5-10.0mm) and the high-speed-drill group (5.0mm, range:3.2-8.7mm)(p=0.01). There was a statistically significant difference in early visual outcomes between groups. Only 12.5% of patients(n=2) in the SONOPET group had new early visual deficits compared to 47.1% (n=8) in the high-speed drill group(p=0.04).
Conclusions: The use of the SONOPET Ultrasonic Aspirator for anterior clinoidectomy is associated with improved early visual outcomes for ophthalmic region aneurysms compared to the use of the high-speed drill. Further studies are needed to better understand the mechanism behind this finding.
Patient Care: The use of this technology may allow for improved visual outcomes following surgery for a subset of aneurysm patients
Learning Objectives: By the conclusion of this session, participants should be able to: Understand the use of the SONOPET Ultrasonic Aspirator for anterior clinoidectomy is associated with improved early visual outcomes in patients with ophthalmic region aneurysms when compared to the use of the high-speed drill.