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AJNR - American Journal of Neuroradiology

Published ahead of print on October 9, 2007
doi: 10.3174/ajnr.A0734

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Usefulness of MR Imaging for the Assessment of Nonophthalmic Paraclinoid Aneurysms

L. Thines^a, J.-Y. Gauvrit^b, X. Leclerc^b, D. Le Gars^c, C. Delmaire^b, J.-P. Pruvo^b and J.-P. Lejeune^a

^a Department of Neurosurgery, Centre Hospitalier Régional et Universitaire, Lille, France
^b Department of Neuroradiology, Centre Hospitalier Régional et Universitaire, Lille, France
^c Department of Neurosurgery and Anatomy, Centre Hospitalier Régional et Universitaire, Amiens, France

View larger version (123K): [in this window] [in a new window]   Fig 1. Paraclinoid MR protocol in a control subject showing the 4 reference points. The 4 lines and their angles of intersection correlated with the limits of the distal dural ring plane in each cutting plane. A, B, C, Paraclinoid region in the diaphragmatic plane. D, E, F, Paraclinoid region in the carotid plane. DP indicates diaphragmatic point; CP, clinoid point; DL, diaphragmatic line; CL, clinoid line, ACNE, anterior CSF notch extremity; PCNE, posterior CSF notch extremity; OL, optic line; RL, roof line, DDRP, distal dural ring plane (dotted curve).

View larger version (142K): [in this window] [in a new window]   Fig 2. Radiologic-surgical correlation for a left superolateral paraclinoid aneurysm (case 14). A, DSA of the left ICA (lateral view) showing an aneurysm (arrows) interpreted as transitional with an intracavernous neck and a transitional sac. B, C, PMP in the diaphragmatic plane with an intersection angle showing a supracavernous location of the neck and the sac (DL indicates diaphragmatic line; CL, clinoid line). D, Operative findings confirming the supracavernous location of both neck and sac and showing, after anterior clinoidectomy and opening of the falciform ligament, the aneurysmal (arrowhead) relationship between the ICA and the optic nerve (ON).

View larger version (151K): [in this window] [in a new window]   Fig 3. Comparison between angiogram and PMP for the location of case 2 (arrows). Both examinations show an intracavernous aneurysm (neck and sac intracavernous). A, DSA of the left ICA in the lateral view. B, 3D-DSA of the left ICA in the anterior view. C, PMP in the carotid plane (OL indicates optic line; RL, roof line). D, PMP in the diaphragmatic plane (DL indicates diaphragmatic line; CL, clinoid line).

View larger version (140K): [in this window] [in a new window]   Fig 4. Comparison between angiogram and the PMP for the location of case 13 (arrows). Both examinations show a transitional aneurysm (neck intracavernous and sac transitional). The PMP depicts a widest supracavernous portion than it is suspected on initial DSA. A, DSA of the left ICA in the lateral view. B, 3D-DSA of the left ICA in the anterior view. C, PMP in the carotid plane (OL indicates optic line; RL, roof line). D, PMP in the diaphragmatic plane (DL indicates diaphragmatic line; CL, clinoid line).

View larger version (166K): [in this window] [in a new window]   Fig 5. Comparison between angiogram and PMP for the location of case 11 (arrows). Both examinations show a transitional aneurysm (neck supracavernous and sac transitional). The PMP depicts a wider supracavernous portion than is suspected on initial DSA. A, DSA of the left ICA in the lateral view. B, DSA of the left ICA in the anterior view. C, PMP in the carotid plane (OL indicates optic line; RL, roof line). D, PMP in the diaphragmatic plane (DL indicates diaphragmatic line; CL, clinoid line).