Microsurgical opening of the carotid dural rings: how I do it

TL;DR

This paper describes a microsurgical technique for managing paraclinoid aneurysms by opening the carotid dural rings, improving access and surgical outcomes.

Contribution

A systematic microsurgical technique for opening the carotid dural rings during paraclinoid aneurysm clipping is presented.

Findings

Resecting the anterior clinoid process extradurally allows exposure of the distal dural ring.

Cutting the dural ring around the carotid artery provides space for proximal vascular control.

The technique is effective when combined with pterional or keyhole approaches for aneurysm clipping.

Abstract

Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical complexity of this region and the technical difficulties involved in accessing this location.

In this work, we describe the surgical technique used to manage paraclinoid aneurysms, as exemplified through a clinical case. The distal dural ring (DDR) is exposed after the anterior clinoid process is resected extradurally. Then, the DDR is cut around the dorsal part of the carotid artery, moving toward the dura covering the optic nerve (ON). After, the lateral and ventral part of the ring is cut until the artery is freed from the dural attachment. The space between the proximal and DDR is visible and can be used as a proximal vascular control site if needed.

Microsurgical clipping of paraclinoid aneurysms through a pterional or a keyhole approach, combined with a systematic technique for opening the carotid rings, is an excellent strategy for exposing and clipping paraclinoid aneurysms, yielding favorable clinical and surgical outcomes.

The online version contains supplementary material available at 10.1007/s00701-025-06673-7.

Figures