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Objective <p>This study aims to anatomically define and clinically evaluate the subchiasmatic-preinfundibular space (SCPIS) as an alternative surgical space for clipping contralateral ICA C7-segment aneurysms, by comparing its outcomes with those of the standard prechiasmatic space (PCS) and contralateral opticocarotid space (OCS).</p> Methods <p>Basic Research: Five cadaveric heads were dissected via the pterional approach. Contralateral ICA exposure was measured through three spaces— PCS, contralateral OCS), and SCPIS—before and after anterior clinoid process (ACP) drilling.&#xa0;Clinical Research:&#xa0;A retrospective analysis of 53 patients with multiple intracranial aneurysms (MIAs) treated via unilateral craniotomy compared outcomes across three groups: SCPIS (Group 1), PCS (Group 2), and contralateral OCS (Group 3). Postoperative aneurysm occlusion rates, complications, discharge mRS scores, and 6-month neurological deficits were assessed.</p> Results <p>The lengths of the contralateral ICA exposure increased significantly post-ACP drilling: PCS (5.62 ± 0.91&#xa0;mm vs. 7.11 ± 0.84&#xa0;mm,&#xa0;<i>p</i> &lt; 0.001), contralateral OCS (4.44 ± 2.33&#xa0;mm vs. 6.03 ± 2.30&#xa0;mm,&#xa0;<i>p</i> = 0.001), and SCPIS (4.98 ± 1.91&#xa0;mm vs. 6.67 ± 2.01&#xa0;mm,&#xa0;<i>p</i> &lt; 0.001). Significant increases were also observed in the lengths of the inferior border of the optic chiasm and/or optic nerves, the deep superior border of the diaphragma sellae, and the area of this space after ACP drilling (<i>p</i> &lt; 0.05). SCPIS clipping showed no significant differences in hospitalization duration, complications (pneumonia, electrolyte disturbances, optic nerve injury, cerebral infarction), or discharge mRS scores (<i>p</i> &gt; 0.05) compared to other approaches. The rate of complete angiographic occlusion of the contralateral aneurysms was comparable among the three groups (PCS: 88.6%, OCS: 90.9%, SCPIS: 85.7%; <i>p</i> = 0.92). Six-month neurological outcomes were satisfactory.</p> Conclusion <p>SCPIS is a viable alternative for contralateral ICA C7-segment aneurysm clipping. ACP drilling improves surgical access, and the approach is safe and effective.</p>

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Comparative anatomical and clinical evaluation of three surgical spaces for contralateral internal carotid artery C7-segment aneurysm clipping: the role of the subchiasmatic-preinfundibular space

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月27日

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  • Xiaoliang Wang,
  • Shiliang Wang,
  • Shang Gao,
  • Xuebin Wang,
  • Yang Wu,
  • Hailong Du,
  • Chao Zhang,
  • Lei Zhao,
  • Xiaosong Liu,
  • Xiaomeng Liu,
  • Gengshen Zhang,
  • Jianliang Wu

摘要

Objective

This study aims to anatomically define and clinically evaluate the subchiasmatic-preinfundibular space (SCPIS) as an alternative surgical space for clipping contralateral ICA C7-segment aneurysms, by comparing its outcomes with those of the standard prechiasmatic space (PCS) and contralateral opticocarotid space (OCS).

Methods

Basic Research: Five cadaveric heads were dissected via the pterional approach. Contralateral ICA exposure was measured through three spaces— PCS, contralateral OCS), and SCPIS—before and after anterior clinoid process (ACP) drilling. Clinical Research: A retrospective analysis of 53 patients with multiple intracranial aneurysms (MIAs) treated via unilateral craniotomy compared outcomes across three groups: SCPIS (Group 1), PCS (Group 2), and contralateral OCS (Group 3). Postoperative aneurysm occlusion rates, complications, discharge mRS scores, and 6-month neurological deficits were assessed.

Results

The lengths of the contralateral ICA exposure increased significantly post-ACP drilling: PCS (5.62 ± 0.91 mm vs. 7.11 ± 0.84 mm, p < 0.001), contralateral OCS (4.44 ± 2.33 mm vs. 6.03 ± 2.30 mm, p = 0.001), and SCPIS (4.98 ± 1.91 mm vs. 6.67 ± 2.01 mm, p < 0.001). Significant increases were also observed in the lengths of the inferior border of the optic chiasm and/or optic nerves, the deep superior border of the diaphragma sellae, and the area of this space after ACP drilling (p < 0.05). SCPIS clipping showed no significant differences in hospitalization duration, complications (pneumonia, electrolyte disturbances, optic nerve injury, cerebral infarction), or discharge mRS scores (p > 0.05) compared to other approaches. The rate of complete angiographic occlusion of the contralateral aneurysms was comparable among the three groups (PCS: 88.6%, OCS: 90.9%, SCPIS: 85.7%; p = 0.92). Six-month neurological outcomes were satisfactory.

Conclusion

SCPIS is a viable alternative for contralateral ICA C7-segment aneurysm clipping. ACP drilling improves surgical access, and the approach is safe and effective.