Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

Abstract

Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

Optic Foraminotomy for Clipping of Superior Carotid-Ophthalmic Aneurysms

“…In our opinion, this dural flap can be dangerous during the drilling of the roof of the optic canal because it can get rolled in the drill and produce optic nerve injuries. Since then, many papers have been reported supporting clinoidectomy and unroofing of the optic canal as the microsurgical approach for clipping carotid-ophthalmic aneurysms ( 1 , 3 , 4 , 11 , 27 , 29 ).…”

“…Aneurysms occurring in this segment are relatively rare and account for 0.5–11% of all intracranial aneurysms ( 2 – 5 ). A higher incidence in females and left-sided predominance of carotid-ophthalmic artery aneurysms have been reported ( 2 , 3 , 6 – 11 ). These are frequently large or giant, and there is a high association with multiple aneurysms (21–64%) ( 7 , 8 , 10 , 12 – 14 ).…”

Endovascular treatment of aneurysms of the paraophthalmic segment of the internal carotid artery: Current status

“…For paraophthalmic segment aneurysms, surgical clipping is still a therapeutic option and should always be considered (98). In a meta-analysis by Falk et al (99) EVT and surgical clipping were compared, and no significant difference in clinical outcome was found between them for ruptured ophthalmic aneurysms.…”

Tratamento Endovascular de Aneurismas Intracranianos Rotos em Pacientes Submetidos a Craniotomia Descompressiva: pode ser viável?

“…Atualmente, os tratamentos para AI correspondem à clipagem microcirúrgica e à embolização percutânea. A clipagem é uma técnica cirúrgica realizada logo após uma craniotomiaabertura da calota craniana, necessitando manejo cuidadoso do parênquima cerebral para se atingir o aneurisma próximo aos vasos da base encefálica para então haver exclusão do fluxo ao aneurisma com o posicionamento de clipe cirúrgico junto ao colo deste 1,3,[8][9][10] . Já o tratamento endovascular é uma técnica minimamente invasiva, realizado sob anestesia geral.…”