Paraclinoid aneurysms, arising from the segment of the internal carotid artery (ICA) located between the distal dural ring (DDR) and takeoff of the posterior communicating artery, represent a unique subset of anterior circulation aneurysms. 1,2 Microsurgical clipping of paraclinoid aneurysms is challenging, given the complicated regional anatomy and difficulty with proximal control. 3 Perhaps these are the main reasons for the relative popularity of endovascular techniques in treating these difficult diseases. 4,5 However, clipping with complete occlusion of the aneurysms and preservation of the parent, branching, and perforating vessels remains the most definitive treatment for paraclinoid aneurysms. We present a 47-year-old woman who was diagnosed with a 2.2-mm superomedially projecting ophthalmic aneurysm, a 4.2-mm laterally projecting paraclinoid aneurysm, and a 2.4-mm intracavernous aneurysm. After discussing possible treatment options, including observation, endovascular treatment, microsurgical clipping, and endoscopic endonasal surgery, the patient opted for definitive endonasal clipping. Given the size and difficult exposure of the intracavernous aneurysm, we plan to continue to observe rather than clip it. Ophthalmic aneurysm can be completely exposed through the initial endoscopic transplanum/transtuberculum approach, while laterally projecting paraclinoid aneurysm requires additional anterior clinoidectomy and opening of the DDR. After temporarily clipping the paraclival ICA, a single straight clip was placed across the neck of each aneurysm under direct endoscopic visualization. Postoperative angiography showed complete obliteration of both aneurysms. The patient consented to the procedure and to the publication of her image. Images at 0:31, 0:38, and 9:26 are republished by Xiao et al, 6 with permission from JNSPG.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.