Microsurgical treatment of ventral (paraclinoid) internal carotid artery aneurysms.

Division of Neurosurgery, Georgetown University Medical Center, Washington, District of Columbia.
Neurosurgery (Impact Factor: 2.53). 02/1988; 22(1 Pt 1):32-9. DOI: 10.1227/00006123-198801010-00005
Source: PubMed

ABSTRACT Eight cases of ventral (paraclinoid) internal carotid artery aneurysms are presented. These aneurysms often challenge the surgeon because (a) they are partially or completely obscured by the optic nerve, internal carotid artery, and anterior clinoid process; (b) there is no proximal internal carotid artery control intracranially; and (c) part of the neck and fundus of the aneurysm is located within the cavernous sinus. These aneurysms, which have been classified as separate from the typical carotid-ophthalmic aneurysm group, are illustrated, and their surgical treatment and problems described.

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    ABSTRACT: The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990-2010). Age, 11-72 years old. Sex, 74:21 female/male. Follow-up; 1-192 months (mean = 51.7 months). Eighty-six patients had single and 9 had multiple paraclinoid aneurysms. Sixty-six were ophthalmic, 14 were in the ICA superior wall, 13 in the inferior, 10 in the medial, and 3 in the ICA lateral wall. Eleven were giant, 29 were large, and 66 were small. Sixty-three patients had ruptured and 32 had unruptured aneurysms. Two patients with bilateral aneurysms had bilateral approaches, totaling 97 procedures. A total of 98.2 % of aneurysms were clipped (complete exclusion in 93.8 %). ICA occlusion occurred in 10 (5.6 %). There was no patient rebleeding during the follow-up period. A good outcome was achieved in 76.8 %, with better results for unruptured aneurysms, worse results for patients with vasospasm, and with no difference according to size. Thirty-six (37.9 %) patients had transient/permanent postoperative neurological deficits (25.4 % ruptured vs. 62.5 % unruptured aneurysms). The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6 %, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.
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    ABSTRACT: The type of paraclinoid aneurysm has been used to decide management methods. Our aim was to assess the relation of the types of paraclinoid aneurysms and outcomes after endovascular treatment and the efficiency of present endovascular techniques. A retrospective analysis was performed on patients with saccular paraclinoid aneurysms that had more than 6 months of angiographic follow-up or recurrence within this period after endovascular treatment from January 2009 to December 2010. Paraclinoid aneurysms were classified into two types and then further into four subtypes by a modified classification method. A classification-based microcatheter shaping method was used in the procedure. The significant risk factors of angiographic results were determined through correlation analysis and logistic regression analysis by SPSS 17.0. There were 64 aneurysms in 56 patients; 28 aneurysms belonged to Type I, while 36 were Type II. A total of 12 aneurysms were managed with coil embolization, and 52 with stent-assisted coiling technique. Our classification-based microcatheter shaping method was successful in all cases. Coil protrusion happened in two cases without severe complications. Recurrence were found in 13 (20.3 %) aneurysms followed up at 12.42 ± 3.78 (mean±SD) months after treatment. The correlation between aneurysm types and immediate angiographic result or follow-up angiographic results did not reach statistical significance. Aneurysm types were not the risk factor of recurrence. The types of paraclinoid aneurysm had not been significant correlated with outcomes of endovascular treatment. Fundus size was the significant risk factor of recurrence after endovascular treatment. A classification-based microcatheter shaping method may be used in endovascular treatment paraclinoid aneurysms. The present endovascular techniques are safe and effective.
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