Skull Base 2005; 15(4): 253-262
DOI: 10.1055/s-2005-918886
ORIGINAL ARTICLE

Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Radiographic Imaging of the Distal Dural Ring for Determining the Intradural or Extradural Location of Aneurysms

Federica Beretta2 , 4 , Ali Nader Sepahi2 , 4 , Mario Zuccarello1 , 2 , 4 , 5 , Thomas A. Tomsick1 , 3 , Jeffrey T. Keller1 , 2 , 4 , 5
  • 1The Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 2Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 3Department of Neuroradiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 4Goodyear Microsurgery Laboratory, Cincinnati, Ohio
  • 5Mayfield Clinic, Cincinnati, Ohio
Further Information

Publication History

Publication Date:
19 October 2005 (online)

ABSTRACT

The effectiveness of several anatomical and radiological landmarks proposed to determine whether an aneurysm is located intradurally or extradurally is still debated. In anatomical and radiological studies, we examined the relationships of the distal dural ring (DDR) to the internal carotid artery (ICA) and surrounding bony structures to aid in the localization of aneurysms near the DDR. Anatomical relationships were examined by performing dissections on 10 specimens (5 formalin-fixed cadaveric heads). After the position of the DDR, optic nerve, and tuberculum sellae were marked with surgical steel wire, radiographs were taken in multiple projections. The only bony landmark consistently visible on radiographs was the planum sphenoidale. The superior border of the DDR is located at or below the level of the tuberculum sellae, which laterally becomes the superomedial aspect of the optic strut; thus, the optic strut marks the dorsal limit of the DDR. On 50 dry skulls, we measured the vertical distance between the planum sphenoidale and medial aspect of the optic strut (5.0 ± 0.4 mm), the interoptic strut distance (14.4 ± 1.4 mm), and the linear distance between the most posterior aspect of the planum sphenoidale (limbus sphenoidale) and the tuberculum sellae (6.0 ± 0.5 mm). Using these measurements and the planum sphenoidale, tuberculum sellae, and optic strut as reference landmarks, we determined the location of the aneurysm relative to the DDR on angiographic images. In this way, we were able to identify whether lesions were intra- or extradural.

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Jeffrey T KellerPh.D. 

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