Speakers

The Learning Curve for Cavernous Sinus Surgery through a Pretemporal Transcavernous Approach
1108 13:20-13:30
Skull Base/304A
Objective: The anatomy of the cavernous sinus (CS) has been well studied in the laboratory for decades; however, performing surgery in and around the CS is still a challenge. To reveal the learning curve for CS surgery via the pretemporal transcavernous approach (PTTC), surgical procedures were examined. The authors proposed 4 levels of surgical difficulty in opening the walls of the CS through this approach. Details of the approach were also illustrated. Methods: Four levels of surgical difficulty were proposed. The higher the level, the more the CS walls were opened. Pathologies corresponding to each level of difficulty in and around the CS were categorized in each level together with explanations. All CS cases from 2009 to 2021 were reviewed and categorized to demonstrate the learning curve. Results: Four levels of surgical difficulty are as follows: level 1, a basic Dolenc extradural approach, which involves opening the anterior third of the superior and lateral walls of the CS; level 2, mobilizing the internal carotid artery (ICA) and opening the proximal dural ring to enter the roof of the CS and treat lesions around the clinoid and upper cavernous ICA; level 3, opening the entire aspect of the superior and lateral walls of the CS, which involves opening the oculomotor triangle and peeling the lateral wall of the CS to the tentorial incisura; and level 4, mobilizing cranial nerves III, IV, and V1 to gain access to the supra-/infratrochlear triangles to have proximal ICA control and opening the posterior wall as the last step to enter the posterior fossa. Surgical steps were described and illustrated with surgical videos of symptomatic intracavernous aneurysm clipping. Conclusions: The learning curve for CS surgery is long. The authors use 4 levels of surgical difficulty to describe applications of the PTTC in CS surgery. This approach serves as an effective workhorse in treating CS pathologies with low morbidity and high success rates when performed by experienced neurosurgeons. Conclusions: The learning curve for CS surgery is long. The authors use 4 levels of surgical difficulty to describe applications of the PTTC in CS surgery. This approach serves as an effective workhorse in treating CS pathologies with low morbidity and high success rates when performed by experienced neurosurgeons.

Aneurysm Clipping: A Surgical Journey in the Era of Endovascular Dominance
1108 15:20-15:30
Cerebrovascular/304B
This is a personal account of aneurysm clipping surgeries performed during the dominant era of endovascular treatments, spanning from 2015 to date. This period marked significant advancements and widespread adoption of endovascular techniques, creating a unique context for traditional surgical approaches. The focus of this presentation is primarily on unruptured aneurysm cases, offering insights into the surgical nuances and decision-making processes that characterized this era. Throughout these nine years, the landscape of aneurysm treatment has been shaped by the increasing preference for endovascular methods due to their minimally invasive nature and promising outcomes. However, this personal experience underscores the continued relevance and critical role of surgical aneurysm clipping in specific scenarios where endovascular techniques may not be suitable or effective. This account reflects on the evolution of surgical practices and the integration of new technologies and methodologies that have enhanced the efficacy and safety of aneurysm clipping. Personal anecdotes and case studies illustrate the adaptability and resilience of surgical teams in navigating the shifting paradigm of aneurysm treatment. This presentation aims to shed light on the enduring value of surgical expertise in aneurysm clipping, emphasizing the importance of maintaining a balanced approach to treatment options in the ever-evolving field of neurosurgery. By sharing these experiences, the goal is to contribute to the ongoing discourse on optimizing patient care and advancing the practice of aneurysm treatment in the contemporary era.