• Masaki Matsumoto, Tohru Mizutani, Tatsuya Sugiyama, Kenji Sumi, Takato Nakajo, and Shintaro Arai.
• Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan. Electronic address: mmatsumoto-oka@umin.ac.jp.
• World Neurosurg. 2019 Apr 1; 124: e498e502e498-e502.

ObjectiveIt is difficult to completely comprehend the anatomy of the structures surrounding the paraclinoid region before aneurysm and tumor treatment therein. When treating paraclinoid aneurysms, it is important to determine the location of the aneurysm as intradural or extradural. Thus, accurate prediction of the position of the distal dural ring (DDR) is necessary. To this end, we focused on the falciform ligament (FL), which is easily visualized on images based on its anatomic features. We measured the distance between the FL and the DDR in patients undergoing paraclinoid aneurysm operations.MethodsBetween January 2017 and July 2018, 15 patients who underwent clipping for paraclinoid aneurysm treatment were retrospectively identified. The distance between the FL and the DDR was measured using a microscale at the time of the operation.ResultsThe patients comprised 14 women and 1 man. The mean aneurysm diameter was 7.29 ± 2.21 mm and the median size was 6.5 mm. Eleven of the aneurysms were on the left and 4 were on the right side. The mean distance between the FL and the DDR was 3.50 ± 0.17 mm and the median distance was 3.50 mm. The distance between the FL and the DDR was almost the same across cases (3.5 mm).ConclusionsThe position of the FL can be easily predicted using preoperative three-dimensional computed tomography angiography based on its anatomic features. In this study, the DDR was located 3.5 mm proximal to the FL along the internal carotid artery. This information is useful for predicting the position of the DDR.Copyright © 2019 Elsevier Inc. All rights reserved.

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